Want to expand health care for women? Allow pharmacists to prescribe birth control

Stories about physician shortages and burnout in the health care field have become all too common since the Covid-19 pandemic. This has been damaging to patients. For example, waiting months to see a primary care doctor for a routine medical visit is not unusual. Connecticut is no exception, and this is particularly concerning because of the state’s antiquated hormonal birth control prescribing policies.      

To their credit, lawmakers in Hartford have recognized the challenges both clinicians and patients face and have introduced Senate Bill 171, which would remove barriers that currently block access to basic birth control products. If the bill passes, pharmacists in Connecticut will be able to prescribe some hormonal contraception directly to consumers.

Connecticut would also join the 24 other states and Washington D.C. that permit pharmacists to prescribe contraception. Considering that the current process for obtaining birth control such as the pill is cumbersome, removing this limitation is a sensible way to both expand access to birth control and increase the number of medical professionals who can prescribe it.

Currently, women in Connecticut have to make a doctor’s appointment for a basic birth control consultation and then head to the pharmacy to fill it. This may seem relatively straightforward, but research shows it’s more vexing than it may appear. Surveys show that 28 percent of women have faced challenges securing birth control prescriptions. This is especially true for women with limited or no health insurance coverage, who live in more rural areas, or lack access to regular and reliable transportation.

And these issues are compounded by the aforementioned shortage of physicians. In Connecticut, approximately 431,000 residents live in a designated primary care Health Professional Shortage Area (HPSA). This means patients can struggle to make appointments in the first place, which the pharmacist-prescribing model can alleviate. Given that there are fewer than 4,000 primary care physicians in the state, empowering the nearly 3,500 pharmacists in the state to prescribe contraception will have an immediate effect on access.

The safety profile associated with birth control has also caused leading physician organizations, such as the American College of Obstetricians and Gynecologists and American Medical Association, to endorse expanding access to hormonal birth control. That is because these medications have a risk level similar to aspirin. Over 3,300 pharmacies across the country now offer contraception appointments with the same standards one would submit to if acquiring birth control at a physician’s office, such as a health screening. Given that pharmacies are more readily accessible than physician’s offices, there are reduced obstacles to obtaining this basic form of reproductive healthcare.

Plus, research shows positive results from pharmacist-prescribed birth control. In the initial two years that Oregon allowed pharmacists to prescribe it, women on Medicaid experienced quality-of-life improvements with an estimated 51 unintentional pregnancies averted. Key to this was that an increased number of birth control prescriptions—10 percent of new hormonal contraception—were written by pharmacists. Additionally, many women who obtained birth control from a pharmacist had not previously used hormonal contraception the prior month, meaning this model reaches new users. This program also saved Oregon $1.6 million over this period, and the cost savings of the pharmacist-prescribing model exceeds the cost of adopting the program.

And Connecticut shouldn’t overlook the potential savings in its own state. The most recent nationally available studies have concluded that unexpected pregnancies accounted for up to 38 percent of all pregnancies in Connecticut costing the state $80 million in health care costs. Women utilizing contraception regularly account for only 5 percent of unplanned pregnancies.

Reports have found that women seeking access to hormonal contraception from pharmacists typically are uninsured and younger than those who would visit a physician. This shows that these women lack the financial resources to visit a physician, proving the necessity of removing barriers to access. While there is no immediate way to alleviate the doctor shortage in Connecticut, by improving access to birth control through pharmacist prescribing, the state can take some of the pressure off both patients and physicians and start moving in the right direction.