When it comes to birth control access, Gov. Whitmer and her colleagues have work to do
Given new uncertainties surrounding reproductive healthcare in the United States, state policymakers face increased pressure to secure birth control access. This past fall, Michigan’s Gov. Gretchen Whitmer announced that she and her colleagues are “taking action” to improve access to contraception. This action, which was simply a reinterpretation of existing regulation, stated that Michigan pharmacists can now prescribe birth control methods like the pill and patch directly to patients. There’s one glaring problem with this announcement: Michigan pharmacists already prescribe birth control.
Currently, about 300 CVS pharmacies in Michigan offer birth control consultations to patients, with the majority of these located in the greater Detroit area. Authorizing pharmacists to prescribe birth control, often called the “pharmacy access” model, is lauded as a low-cost and commonsense approach to improving access to birth control. Under the pharmacy access model, pharmacists require patients to disclose the same medical history that they do with physicians, and then determine whether a patient can be offered a hormonal birth control prescription safely.
Roughly half of all states now allow the pharmacy access model based on its ease and convenience for patients, so Michigan leaders are right to encourage it. But to encourage more pharmacists to prescribe birth control realistically, Gov. Whitmer and Michigan legislators must do more than announce an existing policy. They must address why more pharmacists are not prescribing birth control in the first place.
The primary reason is that pharmacists don’t get reimbursed for doing so. In Michigan, pharmacists are not considered billable providers through Medicare, and therefore cannot receive reimbursements for pharmacist services, including time spent with patients discussing treatments or medications. Many private payers follow Medicare’s guidelines for reimbursement, which makes it even harder to get reimbursed. Gov. Whitmer and her colleagues must count pharmacists as the providers they are and allow them to collect payment for their services.
Further, some Michigan legislators have tried to improve pharmacy access to birth control—not by improving payment mechanisms, but by removing the requirement that Michigan pharmacies must enter collaborative practice agreements (CPAs) with physicians to prescribe birth control. The CPA model—in which written agreements between physicians and pharmacies expressly delegate some duties—is common in some health care practices, but it is not necessary for birth control prescribing.
Of the states with pharmacy access to birth control, many do not require that pharmacists and physicians enter CPAs to do so. Several legislators brought a bill to Lansing in 2021 to update the Michigan regulations to reflect this. The bill, HB 5655, would replace CPAs for birth-control prescribing with a state-wide order granting pharmacists more autonomous prescribing ability for birth control. This may seem like a nitpicky revision, but it’s far from it. Standing orders are essentially statewide permission to prescribe. Pharmacists and researchers have shown that CPAs are more restrictive than standing orders, which could certainly swing the incentive away from more pharmacies offering birth control consultations. Though this change won’t eliminate all the barriers to pharmacy access, Gov. Whitmer should encourage her fellow policymakers to move this legislation forward.
The benefits of ensuring that pharmacists’ abilities are used to the highest degree cannot be understated. In fact, pilot programs throughout Michigan have demonstrated how effective pharmacists are at improving healthcare outcomes when empowered to serve greater roles on health care teams. The Michigan Medicine Hypertension Pharmacists Program, for example, found that pharmacists can help patients with hypertension better control their blood pressure. The program referred patients to a pharmacist at their nearest participating Michigan Medicine clinic or Meijer Pharmacy, where the pharmacist could independently aid the patient with drug and disease maintenance. Creating touchpoints between patients and health care professionals can lead to improved health outcomes, including those related to contraceptive access.
What’s more, allowing pharmacists a greater role in care management can mean big cost savings to state health care systems. Several years ago, a state-wide initiative called the Michigan Primary Care Transformation project began including pharmacists as care managers for patients with chronic issues like hypertension as a way to improve health outcomes and rein in costs. Patient outcomes improved, and the cost savings from the initiative were significant. By 2014, total Medicare expenditures were reduced by nearly $300 million, hospital admissions went down and medical specialist visits were reduced. Financially, enabling pharmacists to prescribe birth control could accelerate savings to insurers and reduce the time and cost spent accessing reproductive care for patients.
Pharmacy access to birth control is neither a new nor bad idea. If Gov. Whitmer wants to encourage contraceptive access in pharmacies, then allowing insurance billing and eliminating CPA requirements to prescribe birth control are concrete steps she can take. Expressed support of pharmacy access is one thing, but it’s time for Michigan policymakers to take concrete action toward actively achieving it.
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