Testimony from:
Robert Melvin, Senior Manager, State Government Affairs for the Northeast Region, R Street Institute

R Street Testimony in Support of CT SB 171 “An Act Allowing Pharmacists to Prescribe Birth Control Medication.”

March 6, 2023

Connecticut Joint Public Health Committee

Chairman Anwar, Chairwoman McCarthy Vahey and members of the committee:

My name is Robert Melvin, and I am the senior manager of state government affairs for the Northeast region with 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 deregulating birth control access where appropriate. This is why we support SB 171.

Allowing pharmacists to prescribe birth control—as Senate Bill 171 would permit—removes an important hurdle for individuals who want access to hormonal birth control. Demolishing this obstacle falls in line with what 25 states and Washington, D.C. already permit.[1]

In Connecticut, if a woman wants to acquire birth control such as the pill, she typically must make a trip to a physician, obtain a written prescription and then head to the pharmacy. Research shows that increasing birth control convenience increases use, and that many women support reducing the need for a doctor to prescribe contraception.[2] Streamlining the process by allowing pharmacists to prescribe birth control does not sacrifice safety, and has an outsized positive impact on women with limited or no health insurance coverage, who live in rural areas, or lack access to regular and reliable transportation.[3]

The safety profile associated with birth control has prompted leading physician organizations, such as the American College of Obstetricians and Gynecologists (ACOG) and American Medical Association, to endorse removing prescription barriers to hormonal birth control altogether.[4] That is because these medications have a risk level similar to aspirin.[5] The pharmacist-prescribing model does not even go as far as allowing complete over-the-counter access, since patients would still be required to see a highly trained pharmacist who must examine them for any contraindications.

Early reviews of this model in other states have yielded promising results. During the first two years of the program in Oregon, those in the Medicaid population saw an improvement in quality of life, with an estimated 51 unintended pregnancies averted and increased birth control prescriptions.[6] By the end of the first two years, 10 percent of new oral and transdermal contraception prescriptions were written by a pharmacist. A large majority of the women receiving any kind of birth control from a pharmacist had not been using a contraception method in the prior month—indicating that this program reached people previously unsupported by the system. This program also saved Oregon $1.6 million in the same two years.[7] As has been pointed out, the cost savings from pharmacist prescriptions exceeds the cost of program implementation.[8]

The potential cost savings in Connecticut should not be overlooked. The latest nationwide research available shows that, in 2017, 38 percent of all pregnancies in Connecticut were unintentional.[9] This resulted in associated state health care costs of over $80 million.[10] It is worth noting that women who consistently use contraception only account for 5 percent of unintentional pregnancies.[11]

Financial considerations go beyond the state’s bottom line. Studies have shown that women who seek out birth control prescriptions from pharmacists tend to be uninsured and younger than women who would see a physician.[12] This suggests that they lack the financial resources to visit a physician, and the pharmacist-prescribing model meets them where they are.

The R Street Institute urges you to consider the net benefits of SB 171. If passed, this bill will allow pharmacists to play a part in increasing access to birth control; rein in costs associated with unintended pregnancies; and remove barriers to obtaining this vital family planning resource for those who are lower income and uninsured. Leading physician groups support efforts to permit greater access to birth control because it is safe and effective. For these reasons, we strongly urge your favorable consideration of SB 171.         

Thank you,

Robert Melvin
Senior Manager, Government Affairs for the 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] The American College of Obstetricians and Gynecologists, “Committee Opinion Number 788: Over-the-Counter Access to Hormonal Contraception,” Obstetrics and Gynecology 134 (October 2019). 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 2, 2018. https://archive.ocsotc.org/wp-content/uploads/2018/06/2018-AMA-OCs-OTC-resolution-110-A-17.pdf.

[5] The American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception.

[6] Maria I Rodriguez et al., “Association of Pharmacists 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,” OHSU, 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.

[7] Ibid.

[8] “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.

[9] 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.

[10] “State Facts about Unintended Pregnancy: Connecticut,” Guttmacher Institute, 2016. https://www.guttmacher.org/sites/default/files/factsheet/ct_8_0.pdf

[11] Ibid.

[12] Maria I Rodriguez et al., “Association of Pharmacist Prescription with Dispensed Duration of Hormonal Contraception,” Obstetrics and Gynecology 3:5 (May 20, 2020). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766072.