Testimony from:

Lauren L. Rollins, Fellow and Editorial Director, R Street Institute

In SUPPORT of S. 1309, “AN ACT Relative to Hormonal Contraceptives”

September 10, 2019

Joint Committee on Public Health

Chairs Comerford and Mahoney, Vice Chairs Collins and Tyler, and members of the Joint Committee on Public Health:

Thank you for considering my testimony. My name is Lauren L. Rollins and I am a resident of Massachusetts, as well as a research fellow and the Editorial Director for the R Street Institute, a nonprofit, nonpartisan public policy research organization. Our mission is to engage in policy research and outreach to promote free markets and limited, effective government in many areas, including consumer freedom and the overly burdensome professional licensing regimes that often hinder that freedom. This is why S. 1309 is of special interest to us.

Women’s access to birth control in the United States remains stymied by regulations that only allow physicians—and some advanced practice clinicians—to prescribe hormonal contraception. However, in the last few years, 12 states and the District of Columbia have begun to allow pharmacists to do so as well.[1] This “pharmacy access” model is beneficial in several important ways, and should this bill pass in Massachusetts, our state would join the growing list of states dedicated to improving women’s access to contraception.

Traditionally, to obtain hormonal contraception like birth control pills, a woman must schedule an appointment with her doctor where she will answer a few relevant questions about her medical history and have her blood pressure checked. Only then is she able to fill her prescription at a pharmacy. But this doctor’s visit is unnecessary. So much so, in fact, that leading medical organizations, such as the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Medical Association all recommend removing the prescription requirement to allow over-the-counter access.[2] These groups have endorsed such a move because of birth control’s long and well-established record of safety: the pill was approved by the FDA 60 years ago and has proven to be safe, effective and crucial to a woman’s ability to plan her own family.

While such a move toward full over-the-counter access for birth control would require federal reform, state-based pharmacy access legislation would significantly reduce the burdens inherent in modern contraceptive access. Instead of having to visit a doctor’s office as an intermediary step, women would be able to go directly to a pharmacy to receive birth control.

Pharmacists are already expertly trained in medication interactions and advise patients face-to-face on a daily basis. Accordingly, allowing them to prescribe birth control is a natural extension of their training and abilities. And the pharmacy access model would especially help those who have a difficult time obtaining birth control, such as uninsured women, women living in rural areas, and those who simply can’t afford the time and money associated with a doctor visit. And indeed, the available empirical evidence demonstrates the model’s benefits. For example, in just the first two years of pharmacy access in Oregon, pharmacists have already written 10 percent of new birth control prescriptions for Medicaid patients (all of whom had not previously been using hormonal contraception).[3]

Greater birth control access also brings another important benefit: reducing unintended pregnancies. Unplanned pregnancies disproportionately harm lower-income and less-educated women, in terms of health outcomes and socioeconomic achievement—both for the mothers and their children.[4] Nearly half (47 percent) of pregnancies in Massachusetts are unintended.[5] This not only affects women and their families, but it also impacts public expenditures, given that medical costs associated with unintended pregnancies are often significant. In 2010, for example, federal and state governments spent a combined $21 billion on unintended pregnancies.[6] That same year, Massachusetts taxpayers directly covered $138 million for unintended pregnancies in our state.[7]

Combined with evidence from states that have already adopted it, these numbers suggest that allowing pharmacists to prescribe birth control makes it more widely available, reduces unintended pregnancy rates and eases the financial burden on the public healthcare system.[8]

Based on these many benefits, Massachusetts should act promptly to adopt the pharmacy access model, which is catching on in places as politically diverse as D.C. and Utah for good reason. Better and more convenient birth control access benefits women, their families, the medical community, and Massachusetts taxpayers. And for these reasons, I urge the committee to pass S. 1309.

Thank you for your time,

Lauren L. Rollins

Research Fellow and Editorial Director

R Street Institute

703-402-2853

lrollins@rstreet.org

[1] Courtney Joslin and Steven Greenhut, “Birth control in the states: A review of efforts to expand access,” R Street Policy Study No. 159, November 2018.  https://www.rstreet.org/2018/11/21/birth-control-in-the-states-a-review-of-efforts-to-expand-access.

[2] See, e.g., The Committee on Healthcare for Underserved Women, “Opinion: Access to Contraceptives,” The American College of Obstetricians and Gynecologists, 2015 (issued) and 2017 (reaffirmed).

https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives?IsMobileSet=false; “Over-the-Counter Oral Contraceptives,” The American Academy of Family Physicians, March 2019. https://www.aafp.org/about/policies/all/otc-oral-contraceptives.html; Gerald E. Harmon, MD, “Over-the-Counter Contraceptive Drug Access (Resolution 110-A-17),” The American Medical Association, 2018. http://ocsotc.org/wp-content/uploads/2018/06/2018-AMA-OCs-OTC-resolution-110-A-17.pdf.

[3] Tracy Brawley, “Pharmacist-prescribed birth control reaches new users, saves Oregon $1.6M,” Oregon Health and Science University, May 9, 2019. https://news.ohsu.edu/2019/05/09/pharmacists-prescribed-birth-control-reaches-new-contraceptive-users-saves-oregon-1-6-million-in-public-costs.

[4] See, e.g., Kathryn Kost and Laura Lindberg, “Pregnancy Intentions, Maternal Behaviors, and Infant Health: Investigating Relationships with New Measures and Propensity Score Analysis,” Demography 52:1 (February 2015), pp. 83-111. https://link.springer.com/article/10.1007/s13524-014-0359-9; Alison Stewart Ng and Kelleen Kaye, “Teen Childbearing and Child Welfare,” The National Campaign to Prevent Teen and Unplanned Pregnancy, May 2013. https://www.courts.ca.gov/documents/BTB24-2J-11.pdf.

[5] “State Facts About Unintended Pregnancy: Massachusetts,” The Guttmacher Institute, August 2017. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-massachusetts.

[6] Adam Sonfield and Kathryn Kost, “Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care, National and State Estimates for 2010,” The Guttmacher Institute, February 2015. https://www.guttmacher.org/sites/default/files/report_pdf/public-costs-of-up-2010.pdf.

[7] Ibid.

[8] Maria I. Rodriguez et al., “Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs,” Obstetrics & Gynecology 133:6 (June 2019), pp. 1238-46. https://journals.lww.com/greenjournal/Citation/2019/06000/Association_of_Pharmacist_Prescription_of_Hormonal.23.aspx.