Expanding the Frontiers of Pharmacy Practice (III)
Casey Tak, PhD, MPH - University of North Carolina Eschelman School of Pharmacy and - Karen Gunning, PharmD, BCPS, BCACP - University of Utah College of Pharmacy - talk with us about hormonal contraception and how pharmacists in community and ambulatory care settings can increase women's access to care. Key Lessons: A variety of contraceptive methods have been available through pharmacies for decades but many states now permit pharmacists to directly "provide" hormonal contraception without a prescription. A state-wide standing order is the most common mechanism for authorizing pharmacists to provide hormonal contraception directly to patients, but state laws and regulations vary. The CDC Guidance for Healthcare Providers - US Medical Eligibility Criteria do not require a woman to have a pelvic exam prior to receiving hormonal contraception. The pharmacist needs to ask about and document the patient's medical and medication history, take the patient's blood pressure, and inquire about contraceptive preferences before providing hormonal contraception. Some states require pharmacists to refer patients to a primary care provider to receive recommended preventive care, such as pelvic exams, breast exams, and Pap smears. Even when this is not required by state law, it's a best practice to ensure all women are receiving appropriate health maintenance services. Insurance coverage for pharmacist-provided hormonal contraception is not universal - many private insurance plans do not cover the cost of hormonal contraception or compensate for the pharmacist's time. However, Medicaid programs often do (varies by state). Increasing access to hormonal contraception is good public policy because it can positively impact Medicaid costs by reducing unintended pregnancies, high-risk pregnancies, and infant mortality. Student pharmacists can (and have) played an important role in advocating for pharmacist-provided hormonal contraction.