Allowing pharmacists to prescribe birth control in Oregon has increased access and saved money, even if few women know about the option.
Researchers at Oregon Health & Science University published two studies this week reviewing Medicaid billing data to assess the first two years of the pharmacists prescribing. They found that from January 2016 through December 2017, 162 pharmacists prescribed contraceptives for 367 women on Medicaid, also known as the Oregon Health Plan. This resulted in 1,313 filled prescriptions. About 10 percent of women using birth control pills or patches under the Oregon Health Plan got their prescriptions from a pharmacist.
“The vast majority — nearly 74% — weren’t using contraception in the month before they got care from a pharmacist,” said Dr. Maria Rodriguez, an assistant professor of obstetrics and gynecology at OHSU and a co-author of both studies. “This suggests they were at risk for unintended pregnancy, and that the policy is really reaching the women we want it to.”
Nearly 62% of the women had no bills for contraception through OHP in the prior six months. It is possible, the authors said, that some of these women were receiving birth control through Title X programs or paying cash. The researchers did not have access to prescribing data from private insurers.
The researchers modeled the number of unintended pregnancies that would occur with and without pharmacists prescribing. The model found that in the first two years, Oregon avoided 51 unintended pregnancies among women on Medicaid, saving the state $1.6 million in medical care costs, including childbirth, newborn care and other services.
The bill establishing the program was passed by the Legislature in 2015 and authorized pharmacists to prescribe hormonal birth control pills and patches after completing a five-hour training program. In 2017, the Legislature expanded pharmacists’ prescribing authority to include injectable contraception and birth control rings.
As of late 2017, 1,300 of the estimated 1,600 retail pharmacists in Oregon had been certified to prescribe, and 68 percent of Oregon ZIP codes had at least one pharmacist who had completed the training. Pharmacies are often open later in the evening and over the weekend when physician clinics are closed. That could help lower barriers for women to get a prescription.
Nearly all of the prescriptions, 94%, were filled in retail chain pharmacies, mostly in urban locations. Rodriguez said that reflects the commitment that chains like Safeway-Albertson’s, Fred Meyer and Rite Aid have made to have their pharmacists trained to prescribe.
Still, a report issued last year suggested that finding a pharmacist to prescribe birth control remained challenging.
The researchers found that about 5% of patients getting prescriptions from their pharmacist had conditions for which hormonal birth control is not recommended, similar to the rate seen among doctors and nurse practitioners.
Six other states — California, Colorado, Hawaii, New Mexico, Utah and Washington — have passed similar laws, while Maryland, Tennessee and Washington, D.C., are expected to join them soon. Oregon was the first in the nation, and other states have been following the rollout of the state’s program.
Rodriguez is also involved in a broader study measuring the impact of the new laws. The researchers will follow some 300 women across four states to gain insight into their motivation and intent when seeking care from pharmacists.
Rodriguez said more work needed to be done to help Oregon pharmacists understand how to bill for their time in consulting with patients, and to convince all private insurance plans to cover the service.
“What we’re seeing in these preliminary findings is that this is an option that women like, are utilizing, and it’s increasing access for women who are at risk for unintended pregnancy,” she said. “It still amazes me the number of women who use contraception that have never heard of it.”
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