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Drugstore Doctors

By Marissa Evans, CQ Staff

August 5, 2015 -- Pharmacists in California and Oregon will soon be able to prescribe birth control to women right over the counter, encroaching on another medical service that was once the exclusive province of doctors.

The two states will be the first in the country to allow pharmacists to prescribe contraceptives on their own, without a doctor's prescription.

California legislators passed their bill in 2013 and the law goes into effect Oct. 1. Oregon Gov. Kate Brown, a Democrat, signed her state's bill July 6 and it takes effect Jan. 1.

The two laws are part of a broader trend in states seeking efficiencies in health care as more residents become insured and doctors struggle with increased demands for their services. For instance, 21 states and the District of Columbia have given nurse practitioners the ability to practice without doctor supervision.

Krystalyn Weaver, director of policy and state relations for the National Alliance of State Pharmacy Associations, says pharmacists receive universal training in pharmacology school but most states don't take advantage of that experience. "Pharmacists are very highly trained and that education is focused on optimizing drug therapy to make health outcomes as good as they can be," Weaver says. "It does take time, not everyone is meant to be on certain kinds of birth control. There's some brainwork involved with prescribing medication."

The expansion of authority for pharmacists in California and Oregon, as well as greater roles for nurse practitioners in other states, have drawn criticism from physicians who argue that only they have the proper training to prescribe certain medications or provide primary services. Others, they say, should be required to give such care only under a doctor's supervision.

"The American Medical Association encourages physician-led health care teams that ensure health care clinicians work together as the ideal way to provide high quality and efficient care," the organization said in an email statement. "Innovative physician-led team models across the country are achieving improved care and patient health, while reducing costs. Pharmacists are valuable members of this team, and patients win when each member of their health care team plays the role they are educated and trained to play."

Oregon and California are "trying to bring pharmacists more into the fold of utilizing their skills," says John Norton, director of public relations for the National Community Pharmacists Association. "Pharmacists are the most accessible health care provider out there. You can drop by anytime you want and get your services.... It makes health care more accessible and easier to do from a patient perspective."

California's new law allows pharmacists to get additional training to prescribe contraceptives and establishes new training and licensing standards for "advanced practice pharmacists."

Oregon's bill allows pharmacists to prescribe birth control medication and devices to women and amends the definition of "practice of pharmacy" in the licensing statutes to include prescribing such products.

Even as California prepares for the law to go into effect in October, questions loom regarding the kind of training pharmacists will have to complete, how consumers will find advanced practice pharmacists, whether consumers will pay more to pharmacists for counseling and whether such fees will be covered by insurance companies.

Other states will be watching the two states closely, says Elizabeth Nash, senior state issues associate at the Guttmacher Institute, a nonprofit that advocates for reproductive health services.

"We haven't seen it implemented, so it's hard for other states to envision how it would work in their state," Nash says. "We're going to have two examples and there might be momentum to see if this is an option for them. Once you have a couple of examples, people want to take a wait-and-see approach so they have an idea of what to expect and how to make it a smooth process."

Pharmacists in other states do have some experience with contraceptives. A Guttmacher report last month found that Alaska, California, Hawaii, Massachusetts, New Hampshire, Vermont and Washington allow pharmacists to provide emergency contraception without a prescription when acting under a collaborative-practice agreement with a physician. California, Maine and New

Mexico allow pharmacists to do so under state-approved protocols.

Arizona, Arkansas, Georgia, Idaho, Mississippi, and South Dakota are among states that allow pharmacists to refuse to give contraceptives, including emergency contraception.

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