Testimony on Wisconsin Assembly Bill 176 Regarding Pharmacist-Prescribed Contraception
Chair Moses and Vice-Chair Rozar, and members of the committee,
Thank you for the opportunity to testify regarding Assembly Bill 176, which would allow pharmacists to prescribe certain contraceptives. My name is Courtney Joslin, and I am a resident fellow and senior manager at the R Street Institute (RSI), a nonpartisan public policy research organization that prioritizes free markets and limited, effective government. My research focuses on health care disintermediation and scope of practice reform. Since 2018, I have studied how the pharmacy access model works, and I have worked with a number of states on how to implement best practices for this model.
In Wisconsin, a patient seeking a hormonal birth control prescription must make an appointment with a doctor or advanced practice nurse, answer a mandatory list of questions regarding their health, and then—if it is safe for them to use a hormonal contraceptive method—they are given a prescription that must be filled at a pharmacy. Many Americans are familiar with the difficulties of attempting to make a doctor’s appointment, and either being told it will be a couple months before the next available appointment, or being added to a wait list to stand by for a cancellation. For women with children and/or jobs, that sort of flexibility is simply unrealistic. This is worsened by the fact that the Wisconsin Department of Health Services reports 45 percent of counties in the state have a shortage of primary care physicians.[1] For contraception to work most effectively, it must be used without interruption, but the current state of the Wisconsin medical system creates significant risk of interruption.
The medical community at large agrees that the process for birth control prescriptions is overly burdensome for providers, too. Groups such as the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians have highlighted that an office visit for a birth control prescription is so straightforward that the vast majority of patients could forgo seeing a doctor for this purpose.[2] They also note that birth control consultations involve no form of pelvic or gynecological exam, and instead a questionnaire is all that is required. Pharmacists are capable of taking this on, and in many states, they already do. In all, pharmacists seeking to provide hormonal birth control are required to take a contraception-specific continuing education course, so they are fully trained before counseling patients. Further, to ensure that only qualified patients receive birth control, pharmacists in all states are required to advise patients to see a primary care physician if they believe a patient is contraindicated for hormonal birth control.
Currently, half of all states, plus Washington, D.C., allow pharmacists to prescribe contraception.[3] While RSI does not take a position on abortion, a number of states—such as South Carolina, Arkansas, Tennessee, and West Virginia—have introduced the pharmacy access model as a tool to reduce unintended pregnancies and subsequent abortions.[4] For example, researchers in Oregon studied whether there were changes to the Medicaid population post-implementation of the pharmacy access model.[5] They found a slight reduction in unintended pregnancy numbers, and $1.6 million fewer taxpayer dollars spent on the associated health care costs.[6]
Patients also report being satisfied with this model of access. They cite pharmacists as more convenient to see, less costly and the overwhelming majority say they would like to continue seeing a pharmacist for their prescription.[7]
The popularity of this type of access is also reflected in Americans’ views on contraception overall. In an annual, national Gallup poll, birth control usage consistently tops the list of morally acceptable issues.[8] Over 90 percent of those polled agreed using birth control was morally acceptable. What’s more, regardless of political affiliation, those surveyed agreed that birth control was more morally acceptable than drinking alcohol, wearing fur or getting a divorce.[9]
Pharmacy access is a tool for states to help both patients and providers. Hormonal birth control provided by a pharmacist is completely safe, and Wisconsin could see a reduction in unintended pregnancies and health care costs as a result of its implementation.
Thank you for your consideration,
Courtney Joslin
Resident Fellow and Senior Manager
R Street Institute
www.rstreet.org
Footnotes
[1] Wisconsin Primary Care Office, “Number of Primary Care Physician FTEs Needed to Remove Shortages for the Resident Population,” Wisconsin Department of Health Services, September 2019. https://www.dhs.wisconsin.gov/publications/p0/p00460.pdf.
[2] Michelle Isley and Rebecca H. Allen, “Over-the-Counter Access to Hormonal Contraception,” Obstetricians and Gynecology 134:4 (October 2019). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception; “Over-the-Counter Oral Contraceptives,” American Academy of Family Physicians, last accessed June 6, 2023.
[3] “Pharmacist Prescribing of Hormonal Birth Control,” Power to Decide, May 2023. https://powertodecide.org/what-we-do/information/resource-library/pharmacist-prescribing-hormonal-birth-control.
[4] Kevin Fisher, “CityWatch: Tom Davis and the fight for common-sense medical legislation,” The Post and Courier, June 1, 2022. https://www.postandcourier.com/columbia/opinion/citywatch-tom-davis-and-the-fight-for-common-sense-medical-legislation/article_8857c5d0-dd68-11ec-98b8-939d0f909c25.html; Kelly Reinke, “Law says Tennessee women can get birth control without prescription,” WATE, Aug. 11, 2017. https://www.wate.com/news/tennessee/law-says-tennessee-women-can-get-birth-control-without-prescription; Leanne Shinkle, “Over-the-counter birth control coming to West Virginia,” WSAZ, June 10, 2019. https://www.wsaz.com/content/news/Over-the-counter-birth-control-coming-to-West-Virginia–511094222.html; John Moritz, “Birth-control access bill gets OK in House,” Arkansas Democrat Gazette, March 9, 2021. https://www.arkansasonline.com/news/2021/mar/09/birth-control-access-bill-gets-ok-in-house.
[5] Susannah E. Gibbs and S. Marie Harvey, “Pharmacist prescription and access to hormonal contraception for Medicaid-insured women in Oregon,” Contraception 102:4 (July 8, 2020), pp. 262-266. https://www.contraceptionjournal.org/article/S0010-7824(20)30187-6/fulltext.
[6] Tracy Brawley, “Pharmacist-prescribed birth control reaches new users, saves Oregon $1.6M,” OHSU News, 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] Sally Rafie et al., “Patient experiences with pharmacist prescribed hormonal contraception in California independent and chain pharmacies,” Journal of the American Pharmacist Association 62:1 (January 2022), pp. 378-386. https://pubmed.ncbi.nlm.nih.gov/34996577.
[8] Megan Brenan, “Birth Control Still Tops List of Morally Acceptable Issues,” Gallup, May 29, 2019. https://news.gallup.com/poll/257858/birth-control-tops-list-morally-acceptable-issues.aspx.
[9] Ibid.