Letter in Support of Section 42 in MA House Bill 4040—Expanded Access to Hormonal Contraceptives

August 8, 2023

The Honorable Maura Healey
Governor of Massachusetts
State House Office of the Governor
24 Beacon Street
Room 360
Boston, MA 02133

Re: Support for Section 42 in House Bill 4040—Expanded Access to Hormonal Contraceptives

Governor Healey,

My name is Robert Melvin, and I am the senior manager of state government affairs for the Northeast region at the R Street Institute. The R Street Institute is 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 expanding access to birth control. For this reason, we have a strong interest in Section 42 of House Bill 4040.

Section 42 of H. 4040 would grant pharmacists with the authority to prescribe hormonal contraception, a move that would remove an unnecessary impediment for individuals seeking access to basic medical care. By dismantling this hinderance, pharmacists will be sanctioned to prescribe birth control, and Massachusetts will join the 28 states and Washington, D.C. where this privilege is already permitted.[1]

Currently, if a woman in Massachusetts seeks to obtain contraception—such as the pill or patch—she must go through an elaborate process. By law, she has to first visit a physician or advanced practice registered nurse for a routine consultation, secure a written prescription and then head to her pharmacy to fill it. While this may not appear to be a burdensome process, research has demonstrated this can be a major roadblock for women—in terms of both time and money.[2] In fact, those lacking insurance experience prohibitively high costs.[3]

These deterrents make it more difficult to obtain contraception. Research has found that 28 percent of women have encountered difficulties procuring prescriptions for it, but there are other options.[4] Surveys have revealed profound support among women for eliminating the need for physicians visit to obtain birth control, like the pharmacy access birth control model found in Section 42 of H. 4040.[5] Streamlining the process by allowing pharmacists to prescribe birth control does not undermine safety; rather, it is crucial for women who have limited health insurance coverage, reside in rural areas, or lack sufficient access to regular and reliable transportation.[6]

In Massachusetts, where approximately 528,000 Bay Staters reside in a designated primary care Health Professional Shortage Area (HPSA), residents face greater challenges obtaining medical care.[7] This means that these citizens struggle to make medical appointments to obtain birth control—an issue that could be abated by establishing the pharmacy access model without sacrificing safety.

In fact, birth control’s safety profile has led leading physician groups, such as the American Medical Association and the American College of Obstetricians and Gynecologists, to support making hormonal contraception available over-the-counter.[8] While Section 42 wouldn’t go quite this far, it would enact the pharmacy access model that ensure that many safeguards remain in place, as patients must still interact with a highly trained pharmacist to evaluate for any contraindications.

Studies from other states also provide evidence of favorable outcomes from pharmacist-prescribed birth control. During the initial two years of Oregon’s program, women on Medicaid saw a quality-of-life improvement, and it is estimated that 51 unintentional pregnancies were averted.[9] Birth control prescriptions from pharmacists resulted in an expansion of access to contraception and accounted for 10 percent of all new prescriptions for it.[10] Reports also found a majority of the women who procured any kind of contraception from a pharmacist had not used a birth control method in the previous month, which signifies that the program reached new users. Over the study period, the program saved the state $1.6 million, and the cost savings exceeded the cost of adopting the program.[11]

Massachusetts should not overlook the potential savings. The most recent data available from 2017 shows that 34 percent of all pregnancies were unintentional, costing the state $138.3 million in associated health care costs.[12] Women who consistently use contraception make up only 5 percent of unintended pregnancies.[13]

The financial impacts go beyond the state’s bottom line. Data has shown that women who seek out birth control prescriptions from a pharmacist tend to be uninsured and younger than those who visit a physician, which implies that this subpopulation may lack the financial resources to seek care from a physician and may benefit financially from fewer barriers to access.[14]  

The R Street Institute urges you to consider the benefits of enacting Section 42 in the proposed budget. If adopted, it will streamline the process to obtain hormonal contraception by allowing patients to simply visit a pharmacist, thereby saving them time and money in acquiring this basic family planning resource. Moreover, lower income and uninsured women stand to gain the greatest benefit from this policy, and it would rein in costs related to unintended pregnancies. For these reasons, I strongly encourage favorable action on Section 42 in H. 4040. Thank you for your time and consideration of this request.

Best,

Robert Melvin
Senior Manager, State Government Affairs Northeast Region
R Street Institute
[email protected]

[1] “State Reproductive Health Access Policies,” Power to Decide, last accessed March 1, 2023. https://powertodecide.org/what-we-do/access/state-policy/rh-access-policies/pharmacist-prescribing.

[2] Michelle Long et al., “Interest in Using Over-The-Counter Oral Contraceptive Pills: Findings from the 2022 KFF Women’s Health Survey,” Kaiser Family Foundation, Nov. 3, 2022. https://www.kff.org/womens-health-policy/issue-brief/interest-using-over-the-counter-oral-contraceptive-pills-findings-2022-kff-womens-health-survey.

[3] Ibid.

[4] Amanda Dennis and Daniel Grossman, “Barriers to Contraception and Interest in Over-the-Counter Access Among Low-Income Women: A Qualitative Study,” Perspectives on Sexual and Reproductive Health 44:2 (June 2012), pp. 84-91. https://www.jstor.org/stable/42004105?seq=1#page_scan_tab_contents.

[5] Long et al. https://www.kff.org/womens-health-policy/issue-brief/interest-using-over-the-counter-oral-contraceptive-pills-findings-2022-kff-womens-health-survey.

[6] Ibid. 

[7] “Primary Care Health Professional Shortage Areas (HPSAs),” Kaiser Family Foundation, Sept. 30, 2022. https://www.kff.org/other/state-indicator/primary-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&selectedRows=%7B%22states%22:%7B%22massachusetts%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[8] “Over-the-Counter Access to Hormonal Contraception: Committee Opinion Number 788,” Obstetrics and Gynecology 134:4 (October 2019), pp. e96-e105. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception; Gerald E. Harmon, “Report of the Board of Trustees: Over-the-Counter Contraceptive Drug Access (Resolution 110-A-17),” American Medical Association, May 10, 2018. https://archive.ocsotc.org/wp-content/uploads/2018/06/2018-AMA-OCs-OTC-resolution-110-A-17.pdf.

[9] Maria I. Rodriguez et al., “Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs,” Obstetrics and Gynecology 133:6 (June 2019), pp. 1238-1246. https://pubmed.ncbi.nlm.nih.gov/31135740; 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.

[10] Ibid.

[11] Ibid.; Kierra B. Jones, “Advancing Contraception Access in States Through Expanded Pharmacist Prescribing,” Center for American Progress, Jan. 31, 2023. https://www.americanprogress.org/article/advancing-contraception-access-in-states-through-expanded-pharmacist-prescribing.

[12] Kathryn Kost et al., “Pregnancies and Pregnancy Desires at the State Level: Estimates for 2017 and Trends Since 2012,” Guttmacher Institute, September 2021. https://www.guttmacher.org/report/pregnancy-desires-and-pregnancies-state-level-estimates-2017; “State Facts About Unintended Pregnancy: Massachusetts,” Guttmacher Institute, 2016. https://www.guttmacher.org/sites/default/files/factsheet/ma_18.pdf.

[13] Ibid.

[14] Maria I. Rodriguez et al., “Association of Pharmacist Prescription With Dispensed Duration of Hormonal Contraception,” JAMA Netw Open 3:5 (May 20, 2020). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766072.