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

R Street Testimony in Support of MA S 1430 “An Act Relative to Hormonal Contraceptives.”

June 6, 2023

Massachusetts Joint Committee on Public Health

Chairman Cyr, Chairwoman Decker 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 removing barriers to birth control access where appropriate. This is why we have a particular interest in S 1430.

Senate Bill 1430 would permit pharmacists to prescribe birth control, thereby removing an unnecessary hurdle for individuals seeking access to hormonal contraception. Dismantling this impediment would allow Massachusetts to join 25 states and Washington, D.C. where pharmacists are authorized to prescribe birth control.[1]

Currently in Massachusetts, a woman seeking birth control must go through a multi-step process. She must first visit a physician or advanced practice registered nurse for a simple consultation, secure a written prescription and then head to the pharmacy to fill it. What appears to be a straightforward undertaking in reality is a barrier for women, especially for those lacking insurance.[2] Reports indicate that 28 percent of women have experienced difficulties with obtaining prescriptions for birth control.[3] It should come as no surprise that there is broad support for addressing barriers to obtaining it.

Surveys have demonstrated that making birth control more accessible is not only supported by women, but it also increases its use.[4] This is important, because unplanned pregnancies are still a concern in Massachusetts.[5] This reform would particularly help women who have limited health insurance coverage, reside in rural areas, or lack sufficient access to reliable transportation.[6]

In Massachusetts, approximately 528,000 individuals live in a designated primary care Health Professional Shortage Area (HPSA).[7] Residents in these HPSAs face greater challenges when making appointments with doctors to access birth control, and allowing pharmacists to prescribe it would alleviate this problem.

In addition, leading physician organizations, such as the American Medical Association and the American College of Obstetricians and Gynecologists, support removing the prescription requirements altogether for birth control.[8] These groups point out that these medications have a risk level that is similar to aspirin.[9] The pharmacist-prescribing model does not even go as far as allowing complete over-the-counter access. Patients would still be required to engage with a highly trained pharmacist to assess for any contraindications.

Studies from other states reveal the positive results of pharmacist-prescribed birth control. In the initial two years of Oregon’s program, there was an increase in birth control prescriptions written for women in the Medicaid population, and it is estimated that 51 unintentional pregnancies were prevented.[10] Birth control prescriptions from pharmacists led to an increase in access to reproductive resources and accounted for 10 percent of all new, prescribed hormonal contraception.[11] A majority of women receiving birth control from a pharmacist had not been using a contraceptive method in the prior month—indicating that this program reached people previously unsupported by the system. Over the study period, the program saved the state $1.6 million, and the cost savings exceeded the cost of adopting the program.[12]

Massachusetts should not overlook the anticipated savings. The latest nationwide research available reveals that, in 2017, 34 percent of all pregnancies in the Bay State were unintentional thereby costing the Commonwealth $138.3 million in associated healthcare costs.[13] Further, women who routinely use contraception make up only 5 percent of unintentional pregnancies.[14]

Financial implications go beyond a state’s bottom line. Data has verified that women who seek out contraception from pharmacists tend to be uninsured and younger than women who would visit a physician.[15] This suggests that this subpopulation lacks the resources to visit a physician, and stands the most to benefit from fewer barriers to access.

The R Street Institute urges you to consider benefits conferred by S 1430. If passed, this bill will allow pharmacists to play a larger role in distributing birth control and will streamline the process. This will save women time and money in procuring this basic family planning resource, especially for those who are lower income and uninsured. Leading physician groups recognize the safety and efficacy of these medications. For these reasons, we strongly urge your favorable consideration of S 1430.         

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] 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.

[4] Ibid.

[5] Kathleen Ammon, “3 reasons why unplanned pregnancy rates are falling,” Tufts Medical Center Community Care, last accessed June 5, 2023. https://hhma.org/blog/3-reasons-why-unplanned-pregnancy-rates-are-falling/#:~:text=There%20are%20three%20main%20factors,affordable%20contraception%2C%20and%20better%20education.

[6] 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.

[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] 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.

[9] 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.

[10] 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.

[11] Ibid.

[12] 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.

[13] 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.

[14] Ibid.

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