I am a pharmacist, a pharmacy professor and an unabashed supporter of improved access to contraception, including emergency contraception (EC). Since 1998, I’ve provided over 400 seminars on EC to pharmacists, physicians, nurses and policy makers. To realize the full potential of emergency contraception to back up their birth control, women must be aware of EC, providers must be well trained on EC and it must be readily accessible: accessible in a timely manner, accessible in one’s own community, and accessible financially.
A lot of energy has tragically gone into the spread of misinformation about EC and contraception in general, and providers are not immune to these campaigns. Several studies recently have shown that the less a provider knows about EC, the less likely they are to provide it to patients. But given objective clinical and pharmacological information, almost all health care providers will support and enhance access to EC and other needed reproductive health services.
Several years ago, when clinical EC training and enlightenment came together in my state of Washington, barriers to EC access began to disappear. In 1997, our team of investigators found that only about 2500 prescriptions a year for EC were being written in our state – a state with a population of approximately 6 million. This was a time when emergency contraception was available only to women with a prescription and there were no dedicated EC products on the market. In order to access EC women had to make an appointment with their medical provider. Because of the time delay making an appointment and because many of these providers were not familiar with EC, many of them either refused or otherwise were unable to accommodate their patients’ EC requests.
Pharmacists in Washington State are able to prescribe medications using collaborative agreements with physicians and nurse practitioners. Realizing that many women couldn’t access EC in a timely manner, we began a pharmacist EC training program in 1998 to allow women to access EC via a prescription directly from their pharmacist. Within a few months women were accessing more emergency contraception each month than physicians had been prescribing each year. Provider enlightenment and EC accessibility in the community had never been greater.
At that time EC was, in fact, birth control (BC) pills. We used Ovral™ or other similar BC products with levonorgestrel to create EC. Since women have been instructed for years by their providers to double up their birth control pills if they missed a dose or two, it wasn’t at all difficult to see that doubling up Ovral™ to create EC was essentially the same thing. The only difference was that in one case we called it EC and in the other we called it making up for missed pills. Plan B One Step™ and Next Choice™ still use levonorgestrel in the same way.
Most women today who are at least 17 years of age or older can access EC from a pharmacist as a non-prescription product. Accessibility to EC has been improved by its over-the-counter (OTC) status, but not for everyone or to every product. Without a prescription OTC EC is not normally covered by insurance plans and the new EC product, ella™, is a prescription-only product. If EC and other forms of contraception survive congressional challenges and are made available without a copay, women will still need to acquire a prescription for EC in order for their insurance to cover the cost. So once again, women’s access to EC is impaired if they need to make an appointment with their provider to get an EC prescription written. While some women will benefit by having their provider write an EC prescription in advance of need most women find they need EC when they have none in their possession.
These women, using the pharmacist-as-prescriber model, could have their pharmacist prescribe EC and therefore make the product a payable prescription under most insurance plans. No appointment required and access is enhanced financially, locally, and in a timely manner. If you want to enhance the ability of women to back up their birth control with EC, consider partnering with your state’s pharmacists to make this possible.