“You wined me and dined me, when I was your girl,” sang legendary country and western crooner Loretta Lynn in her 1975 song, “The Pill.” And although her husband promised to show her the world, all she managed to see was “a bed and a doctor bill.” So Lynn promised to tear down his “brooder house” because now she had “the pill.” The song — which was clearly about birth control — was so controversial at the time that it was banned by some radio stations. But it did manage to reach No. 5 on the charts.
Many years later, it’s easy to forget why the song — or the use of such newfangled birth-control products — was so edgy. These days, 62 percent of reproductive-aged women use contraceptive devices, with 28 percent of them choosing hormonal birth-control products such as the pill. Yet surprisingly, federal bureaucratic hurdles still make it unnecessarily difficult and costly for women — especially those with low incomes and those who live in rural areas — to access such products.
Fortunately, a new Nevada bill would address the problem by allowing pharmacists to prescribe oral contraceptives. So far, 10 states — including deep-blue California and deep-red Utah — have passed laws that allow them to do so, provided the pharmacists follow a few simple rules. Nevada should follow suit.
Without such a law, women in Nevada must make an appointment with a physician and undergo an examination to receive a prescription for oral contraceptives. That may not sound like a huge burden to some, but many women lack health insurance and are unable to pay for the required routine visits. Moreover, women in rural areas often lack easy access to doctors, especially OB-GYNs.
Even many women in big cities and suburbs who have health care coverage and easier access to physicians don’t like to go through the hassle of an appointment just to receive a contraceptive prescription. So instead, they rely instead on less-effective means of birth control such as condoms. This is one reason the United States has such a high rate of unwanted pregnancy.
By contrast, pharmacies are ubiquitous. Getting a pharmacists’ checkup is also quicker and less expensive for women than scheduling a visit with a doctor. The model even has bipartisan appeal: Liberals understand that pharmacy access can promote family planning and reproductive choice, while conservatives see it as a commercial-freedom solution that reduces unnecessary regulations that hinder people’s access to the products they want to use.
Nevada’s Senate Bill 361 requires the pharmacist to complete a training program, provide a “self-screening risk assessment tool that the patient must complete” before dispensing the contraception, advise the patient to have an exam with a primary care physician, and provide the patient with a record of the contraceptives that are provided. All of this is reasonable.
The bill also mandates that state Medicaid and other insurance plans pay for such coverage. We generally don’t support regulations that call for private companies to provide particular benefits, but this mandate is not onerous. Health plans usually pay for such prescriptions, and this requirement would merely pay benefits for a pharmacist’s visit rather than a doctor’s visit. And because pharmacist exams are less costly, this could result in a cost savings.
Although a great idea, this pharmacy-access approach only is a stopgap measure. The permanent solution is for the U.S. Food and Drug Administration to allow hormonal birth-control products to be sold on an over-the-counter basis, like other similarly safe products. The American College of Obstetricians and Gynecologists supports the idea, arguing that “decades of use have proven that oral contraceptives are safe for the vast majority of women, and that they are safer than many other medications that are already available over-the-counter.”
The group also finds that women and even teens are remarkably savvy about their own health care and would still regularly see doctors for examinations even if they could obtain birth control over the counter. There really aren’t any serious problems with allowing people to buy these products without a prescription to speak of. But the FDA is a slow-moving regulatory freight train, and even though some pharmaceutical companies are trying to navigate the agency’s Byzantine bureaucracy, approval for over-the-counter birth control may be years away.
State legislation can’t fix the FDA problem, but this bill is a clever way to work around a federal logjam — especially now that the use of the pill is far less controversial than a song about it was 44 years ago.