Support for Budget Amendment Number 350 – Access to Hormonal Contraceptives
Massachusetts General Court
Senate Ways and Means Committee
24 Beacon Street
Boston, MA 02133
Re: Support for Budget Amendment Number 350 – Access to Hormonal Contraceptives
Chairman Rodrigues and Vice Chairwoman Friedman,
We write to you today on behalf of 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. For this reason, we are sharing our support for budget amendment number 350—Access to Hormonal Contraceptives.
Budget amendment number 350 would allow pharmacists to prescribe hormonal birth control. Lowering the barriers to contraception in this way has been shown to improve access for women in other states. By empowering pharmacists to prescribe birth control, Massachusetts will join the 25 states and Washington, D.C. where it is already permitted.
Currently, if a woman in Massachusetts seeks to obtain contraception such as the pill or the patch, she must first visit a physician or advanced practice registered nurse for a routine consultation, secure a written prescription and then head to her pharmacy. While this seems straightforward, research consistently shows this can be a barrier for women—in terms of both time and money. Additionally, the costs are higher for those lacking insurance.
Survey data has found that 28 percent of women have experienced challenges with acquiring prescriptions for birth control. Other research has demonstrated that women overwhelmingly support removing the barrier of needing a physician visit. In fact, removing this obstacle increases use. Further, streamlining the process to permit pharmacists to prescribe birth control does not undermine safety. It does, however, have a significant positive effect on women who have limited health insurance coverage, reside in rural areas, or lack sufficient access to regular and reliable transportation.
In Massachusetts, approximately 528,000 residents reside in a designated primary care Health Professional Shortage Area (HPSA). This means that these residents may be struggling to make appointments with the doctors needed to access birth control—an issue that could be alleviated by allowing pharmacists to do so.
Moreover, the safety profile of birth control has evoked leading physician groups, such as the American Medical Association and the American College of Obstetricians and Gynecologists, to champion efforts to remove prescription barriers to hormonal birth control. These organizations point out that these medications have a risk level similar to aspirin. Further, under the pharmacist-prescribing model, patients would still be required to see a highly trained pharmacist to assess for any contraindications.
Studies from other states also show positive results from pharmacist-prescribed birth control. In the first two years of Oregon’s program, women in the Medicaid population saw a quality-of-life improvement, and it is estimated that 51 unintentional pregnancies were prevented. Birth control prescriptions from pharmacists helped drive an increase in access to birth control and accounted for 10 percent of all new
hormonal contraception prescriptions. Of note, 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 indicates 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.
The potential savings for Massachusetts should not be overlooked. 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. Women who use contraception consistently account for only 5 percent of unintentional pregnancies.
The financial impacts are not necessarily limited to the state’s bottom line. Reports have shown that women who seek out birth control prescriptions from a pharmacist tend to be uninsured and younger than those who visit a physician, suggesting that this subpopulation may lack the financial resources to seek care from a physician and may benefit financially with fewer barriers to access.
The R Street Institute urges you to consider all the benefits of adopting amendment number 350. If passed, this budget amendment will streamline the process to obtain hormonal birth control 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, we strongly urge favorable action on amendment number 350. Thank you for your time and consideration of this request.
Senior Manager, State Government Affairs Northeast Region
R Street Institute
Resident Fellow and Senior Manager, Competition Policy
R Street Institute
 “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.
 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.
 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.
 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.
 “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.
 “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.
 “Over-the-Counter Access to Hormonal Contraception: Committee Opinion Number 788.” https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception.
 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.
 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.
 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.
 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.