Survey: Many pharmacists willing to prescribe medication abortion drugs but need training

Key takeaways:

• Fewer than 50% of respondents were confident in their knowledge of or ability to prescribe medication abortion.
• Hormonal contraceptive Rx barriers included lack of knowledge, training, staff and coverage.

More than two-thirds of pharmacists in California surveyed said they would be willing to prescribe medication abortion, if legally permitted, but more than half reported lacking confidence in their knowledge of abortion drugs.

Since 2016, California pharmacists have been able to prescribe hormonal contraception, but cannot legally prescribe medication abortion.

“Federal regulations on mifepristone recently changed to remove a prior Risk Evaluation and Mitigation Strategies requirement that mifepristone be dispensed in person by a certified prescriber and to allow pharmacists at certified retail pharmacies to dispense mifepristone,” Cathren Cohen, JD, staff attorney at the Center on Reproductive Health, Law and Policy, UCLA School of Law, and colleagues wrote. “Provision of medication abortion in pharmacies thus represents an opportunity to increase access to abortion care and reduce the burden on the health care system.”

Cohen and colleagues conducted the California Pharmacist Study from October to December 2022 and administered a cross-sectional survey to 316 pharmacists (mean age, 40.9 years) who worked at community pharmacies in California. The survey evaluated attitudes toward, knowledge of and confidence in prescribing hormonal contraception, emergency contraception and medication abortion and obtained self-reported pharmacy-level practices.

Results, published in JAMA Network Open, demonstrated that 68.9% of respondents indicated that they would be willing to prescribe medication abortion to pharmacy clients if legally able to. In total, 48.3% of respondents reported being confident in their knowledge of medication abortion, and 40.4% reported being confident in their ability to prescribe medication abortion if legally permitted.

Among respondents, 91% agreed that providing access to hormonal contraception as a prescribing provider is important, and 71.4% reported being confident in prescribing hormonal contraception. Respondents who agreed that providing access to hormonal contraception is important were more likely to be willing to prescribe medication abortion (prevalence ratio [PR] = 3.96; 95% CI, 1.8-8.73) and express confidence in doing so (PR = 2.44; 95% CI, 1.56-3.82) compared with respondents who disagreed about the importance of contraceptive access.

Less than half of respondents (46.8%) worked in a pharmacy providing prescriptions for hormonal contraception, and those who did not reported barriers including lack of knowledge or training (43.6%), insufficient staff or time to add new services (38.9%) and lack of coverage for such services (33.6%).

Study limitations included possible information bias due to relying on pharmacist reports on pharmacy practice to obtain information on pharmacist-prescribe hormonal contraception.

“Implementation barriers identified through this study, and prior research, including lack of pharmacist knowledge, insufficient staff to add new services and lack of insurance coverage for service provision, can be addressed through the development of sexual and reproductive health service training plans and expanded insurance payment for pharmacist-provided services,” the researchers wrote. “Findings also suggest that pharmacies and pharmacists who are already prescribing birth control are likely to be early adopters of pharmacist-prescribed medication abortion and could be prioritized in any future rollout.”