California Women Can Now Get Birth Control w/o A Prescriptio

[alleinesein]

www.latimes.com/local/lanow/la-me-ln-birth-control-law-20160408-story.html

Officials announced Friday that girls and women in California can now drop by their neighborhood pharmacy and pick up birth control pills without a prescription from a doctor. It's not technically over-the-counter, but you can get them by talking to a pharmacist and filling out a questionnaire.

The new option is intended to increase access to birth control and reduce unintended pregnancies. State legislators originally passed the law in 2013 but it was held up in regulatory discussions until Friday.

California becomes the third state after Oregon and Washington to allow women to obtain more types of birth control directly from a pharmacist.

What kinds of birth control can I get? The law covers self-administered hormonal birth control, which means pills, patches, injections and vaginal rings. Anything a doctor would have to insert, such as arm implants and intrauterine devices, or IUDs, you can't get from a pharmacist.



Do I have to be a certain age? No, there's no age minimum.

What will happen when I visit the pharmacy? A pharmacist will take your blood pressure and then ask you to fill out a questionnaire to make sure birth control is safe for you. Then you can ask for a certain kind of birth control, or the pharmacist can recommend one.

Once you've selected a type, the pharmacist will explain how the medicine you've selected works, how to take it and what side effects you might experience. You will also be reminded of the importance of health screenings, such as for cervical cancer, and warned that birth control doesn't protect against sexually-transmitted diseases. Then the pharmacist will give you the medicine along with a birth control fact sheet.

How much does it cost? If your insurance plan pays for your birth control, it should still be covered. It's unclear whether pharmacists will charge for screening patients and dispensing the birth control, but they could.

Can I go pick some up today? Most pharmacy chains said they weren't quite ready to roll out the law on Day One. The best way to find out if your local pharmacy will be participating is to give them a call.

Which other states allow pharmacists to provide hormonal birth control? Women in Washington state as well as in Washington, D.C., have long been able to obtain birth control without a doctor’s prescription. Oregon began allowing pharmacists to dispense hormonal birth control directly to patients earlier this year, though the state’s law only applies to females over the age of 17. Several other states, including Hawaii and Tennessee, proposed legislation similar to California’s earlier this year.

Why can’t California make birth control pills fully over-the-counter? Only the U.S. Food and Drug Administration can decide if a medicine can be available over-the-counter. The most state legislators can do to increase access to birth control is to allow medical providers other than doctors, such as pharmacists, to furnish the medication.

Federal legislation has recently been proposed that would make hormonal birth control truly over-the-counter.

[vicky]

Amazing! This is a very good thing.

[tiramisu]

This is great. Although there's still the affordability worry, but I remember trying to help a client get to the nearest PP and it was just too far out of the way for her.

[mrsukyankee]

That's a great thing. A step in the right direction.

[mrsdewinter]

This is awesome. Hopefully we'll see it on a national level in the future.

[ringstrue]

Very cool! Do you think there are options they can give or is it limited to one generic type.

[wambam]

I love this. But holy crap, it took me like 7-10 different pills before I landed on one that worked for me. I mean, I know they all would have been effective. But I was having two periods a month until I figured out which one was best.

[tiramisu]

Apr 10, 2016 6:45:23 GMT -5 ringstrue said:

Very cool! Do you think there are options they can give or is it limited to one generic type.

Everything I've read says that you can choose one or ask for recommendations, so I'd imagine there are options.

[sugarglider]

Apr 10, 2016 0:32:56 GMT -5 tiramisu said:

This is great. Although there's still the affordability worry, but I remember trying to help a client get to the nearest PP and it was just too far out of the way for her.

CA has excellent options for health insurance through the exchange, and birth control is preventative medicine, so, should be interesting to see the costs. I would think it would be pretty low. It's free for me now and was only $8/month when I didn't have insurance.

I worry about the strain this puts on pharmacists. They're certainly capable of taking blood pressure and asking about family history of blood clots, etc. But they're not going to have past medical records or access to second opinions. What happens when someone takes it who shouldn't? Is their malpractice insurance going to go up? Will they get reimbursed by insurance for the mini-exams they perform or is it up to CVS to eat that cost?

[tiramisu]

Apr 10, 2016 8:54:12 GMT -5 sugarglider said:

Apr 10, 2016 0:32:56 GMT -5 tiramisu said:

This is great. Although there's still the affordability worry, but I remember trying to help a client get to the nearest PP and it was just too far out of the way for her.

CA has excellent options for health insurance through the exchange, and birth control is preventative medicine, so, should be interesting to see the costs. I would think it would be pretty low. It's free for me now and was only $8/month when I didn't have insurance.

I worry about the strain this puts on pharmacists. They're certainly capable of taking blood pressure and asking about family history of blood clots, etc. But they're not going to have past medical records or access to second opinions. What happens when someone takes it who shouldn't? Is their malpractice insurance going to go up? Will they get reimbursed by insurance for the mini-exams they perform or is it up to CVS to eat that cost?

I was thinking of the teenagers I work with. They might not have insurance info from their family.

I didn't think about malpractice insurance, that's a good point. But doctors don't always have full medical records. I've never had a doctor talk to someone for a second opinion on my BC when I used to take it.

I was always the one driving any changes and none of my doctors ever seemed to take concerns I had about it seriously, though they'd change me if I insisted on a new option, so that seems like it would be the same with this new law. Not that it should be that way, of course.

[laurenpetro]

California: The State That Lets You Make Decisions Without A Penis

[penguingrrl]

I like this a lot. And I definitely feel they found a good middle ground by having a pharmacist dispense and check blood pressure and ask family history. I can't take hormonal bc due to it destroying my blood pressure in my early twenties and have bp related issues in pregnancy, so I like a stopgap existing to check that without having to go for a full medical exam, which is costly, time consuming and simply not always possible.

I hope my daughters feel they can come to me when they feel they need bc, but it would be nice to know they have access if they're too private to discuss it with me (luckily we're walking distance to PP, which is who provided my bc and well woman care for a long time).

[aurora]

As someone who almost died from a BC complication with no prior risk factors, I am somewhat torn on this. I mean, of course I support making more options more easily available to women, but I am worried that more women will be harmed without a doctor's supervision. BC is a great thing but it's not completely benign.

[aurora]

Apr 10, 2016 11:27:13 GMT -5 @gracie6414 said:

Apr 10, 2016 10:04:36 GMT -5 aurora said:

As someone who almost died from a BC complication with no prior risk factors, I am somewhat torn on this. I mean, of course I support making more options more easily available to women, but I am worried that more women will be harmed without a doctor's supervision. BC is a great thing but it's not completely benign.

Was the complication something your doctor knew without your knowledge? Or would the complication have been prevented by answering questions/filling out a questionnaire?

Without a barrage of tests, my doctor really isn't doing anything special when he licks a pill for me. He asks I smoke, I say no. He asks if I've ever had a blood clot I say no. He has none of my family history aside from what I tell him when he asks.

In now way am I minimizing what happened to you, I don't know what happened to you. But I think the questionnaire is quite equal to the transaction 98% of patients have with their doctor or at the clinic when asking for BC. I say 98% because I don't know of many complication of BC that could happen even if your doctor knew everyone about you and your family.

Those are good questions, and part of the reason I feel conflicted. I definitely felt the risks were downplayed by my original doctor, and the same thing might have happened with a pharmacist.

[claudiajean]

I feel conflicted because on one hand easier access to birth control is fantastic. But I do worry about unintended consequences, such as overlooked items in history, rushing on the part of the pharmacist, and to some degree, women skipping preventative care in general. I know there have been lots of years I would have skipped my annual if I hadn't been out of bc refills.

Overall, I'm excited about this, but slightly wary as well.

[kadams767]

Apr 10, 2016 12:38:49 GMT -5 claudiajean said:

I feel conflicted because on one hand easier access to birth control is fantastic. But I do worry about unintended consequences, such as overlooked items in history, rushing on the part of the pharmacist, and to some degree, women skipping preventative care in general. I know there have been lots of years I would have skipped my annual if I hadn't been out of bc refills.

Overall, I'm excited about this, but slightly wary as well.

But the AMA recommendation isn't an annual visit anymore, it's every 3 years I believe. But a lot of doctors still won't fill BC refills without this visit, which is kind of prohibitive for specific populations of women. This helps, IMO.

[AJL]

Apr 10, 2016 11:27:13 GMT -5 @gracie6414 said:

Apr 10, 2016 10:04:36 GMT -5 aurora said:

As someone who almost died from a BC complication with no prior risk factors, I am somewhat torn on this. I mean, of course I support making more options more easily available to women, but I am worried that more women will be harmed without a doctor's supervision. BC is a great thing but it's not completely benign.

Was the complication something your doctor knew without your knowledge? Or would the complication have been prevented by answering questions/filling out a questionnaire?

Without a barrage of tests, my doctor really isn't doing anything special when he licks a pill for me. He asks I smoke, I say no. He asks if I've ever had a blood clot I say no. He has none of my family history aside from what I tell him when he asks.

In now way am I minimizing what happened to you, I don't know what happened to you. But I think the questionnaire is quite equal to the transaction 98% of patients have with their doctor or at the clinic when asking for BC. I say 98% because I don't know of many complication of BC that could happen even if your doctor knew everyone about you and your family.

Except maybe making it easier to swallow? I'm sorry! This autocorrect/typo seriously made me bust out laughing.

[Pibs]

Oregon pharmacist jumping in!  I love that other states are exploring this option.  I think it's so much safer than just allowing hormonal birth control to just be straight OTC without any medical oversight. 

This is all outside of my current scope because I work in a clinical setting instead of retail pharmacy but from what I've read in OR (ringstrue), we can prescribe any of the pills and the patch.  NuvaRing is not included in this, and I'm pretty sure Depo is not, either. 

The OR Board of Pharmacy has only approved one training course so far for pharmacists to use prior to being able to prescribe OCPs, and it's a 5-hour class so not your run of the mill continuing education bit.  From the Board's website and toolkit the patient assessment is quite detailed and there are a lot of reasons a pharmacist would be unable to prescribe OCPs (age, smoking, blood pressure, hx of migraines with aura, current medications) and would need to refer the patient to a MD for further workup.  Most practicing pharmacists I know carry their own liability insurance and are covered by their employers.  Putting the burden on patients to provide a truthful medical history makes me feel better about malpractice, as does having the option of not prescribing if I can document a clinically valid reason why (including not being able to reach the pt's PCP to confirm something.  It's a clinical service that is being provided that's got very set limits on what I legally can and cannot do, and patient safety is always going to be my primary concern because it's the best way to cover my ass. 

I am interested to see how this will play out for insurance and billing purposes, especially since it could pretty easily take 30 minutes to an hour to do a full patient assessment.  As far as I know, the only chain that's really rolled it out in force is Safewy.  Wlgrns is still writing their protocol, RA & Freddie's are piloting in a few stores.  Not sure about CVS/Target, Costco or the smaller chains or independent pharmacies.  Pharmacists aren't recognized as medical providers, so it's often hard to get insurance reimbursement. 

[kme]

I'm a little conflicted. On one hand I love the fact that it's easily accessible. On the other one, sometimes the pill is not the best birth control method for some, especially teenagers. I think to make an informed decision a discussion of the different types is important and will only encourage young women to take control of their health.

[sushi]

I'm completely fine with this, ecstatic really. IIRC BCPs are safer than tylenol.

I just hope it doesn't negatively impact people's ability to pay. A script is still required for insurance reimbursement as we saw with plan b.

[sushi]

Andplusalso, as a volunteer with PP in Colorado, we were trained to do the screening (BP, age, smoking, migraines with aura... plus education on other methods). This was nearly 10 years ago, and a pap/annual wasn't required. (It was called the HOPE program: Hormones with option pelvic exam). The NP/Doc had to sign off on our form for them to get the script, but otherwise it was similar to what OR and now CA are doing.

There is research and history. It's not a brand new experiment. Also, other countries have done this already.

Does anyone require liver panels before buying tylenol? Clotting tests before aspirin?

[Deleted]

As a pharmacist that does not do this, I have to applaud the idea. However, the pharmacist should be compensated. Getting people in the store is not enough.
This is how flu shots were sold to us. Doctors in Ontario get $20 a flu shot, a nurse does the shot and gets $14ish. Pharmacists get $7.50. Minus cost of syringe, swab, bandaid etc and the opportunity cost where you could be filling a prescription that brings in $10-12 minimum.
So we were convinced that the people would shop and/or become our customer. Nope. I have seen them. They come in, get a shot and leave.
A lot of times, the measure is promoted as making things easier for the patient when in reality it is to Save the government, insurer or whoever.
But kudos to California for moving forward. We just need the CVS and Wagreens of the world to push for more compensation or deal with slightly less profit by increasing labour force

[ESF]

Pibs, thanks for sharing your experience!

Aside from the benefits that others have pointed out, I think this is a good move for our health care system. One reason costs are so high is all the bureaucracy and hoops we have here. My understanding is that many European countries have pharmacists that do more of this type of stuff, provide routine meds that require prescriptions here without needing a formal doctor visit.

We need to figure out more ways to deliver health care outside of the traditional route. I think this is going to be good for many companies. For example, CVS is moving in a more health-services direction with their minute clinics, so something like this expands the services they could offer as part of that business model. It may encourage other pharmacy chains to do the same. If it works, perhaps regulators will reduce barriers to other kinds of prescriptions.

[imojoebunny]

Lets watch the number of abortions decline! Watch the socio-economic numbers for kids and women go up. This is a huge win for the "Pro-lifers", but they probably won't recognize it, since it doesn't involve suppressing women and children.

I agree with @hannymarren. You cannot expect a pharmacist or anyone to preform an additional function of a medical professional, without compensating their time and risk (just wait, there will be lawsuits for something). Honestly, I trust pharmacist, far more than doctors, when it comes to meds. They also are much more knowledgeable about prices for meds, so the $10 script that works almost or even better vs. the $375 one your doctor prescribed, is much more likely to be filled and followed.

I still think IUDs should be free for all.

[josieposy]

Maybe this was covered, but I've had a long day. Can pharmacists refuse to dispense for religious/moral reasons in CA?

[ESF]

Apr 10, 2016 21:16:49 GMT -5 josieposy said:

Maybe this was covered, but I've had a long day. Can pharmacists refuse to dispense for religious/moral reasons in CA?

Pharmacists likely can in every state, because federal law requires employers to make reasonable accommodations available for employees' religious beliefs. It's not an absolute right, and employers can fire them for being a dick to customers, but if it's just, "I apologize but Jane is going to help you with your order instead" then yes, the pharmacy probably has to accommodate that in the same way they'd have to accommodate a request to not work on the Sabbath, assuming the pharmacy is large enough to employ more than one or two pharmacists.

[josieposy]

Apr 10, 2016 21:43:27 GMT -5 ESF said:

Apr 10, 2016 21:16:49 GMT -5 josieposy said:

Maybe this was covered, but I've had a long day. Can pharmacists refuse to dispense for religious/moral reasons in CA?

Pharmacists likely can in every state, because federal law requires employers to make reasonable accommodations available for employees' religious beliefs. It's not an absolute right, and employers can fire them for being a dick to customers, but if it's just, "I apologize but Jane is going to help you with your order instead" then yes, the pharmacy probably has to accommodate that in the same way they'd have to accommodate a request to not work on the Sabbath, assuming the pharmacy is large enough to employ more than one or two pharmacists.

Thank you.

[StrawberryBlondie]

Will this make people who get them OTC have to pay full retail?

[Pibs]

Apr 11, 2016 12:11:07 GMT -5 StrawberryBlondie said:

Will this make people who get them OTC have to pay full retail?

No, because they're not going to be OTC.  They're still prescription only, but they're prescribed by a pharmacist who has been granted prescriptive authority by the state they're practicing in.

I think it'll be interesting to see how this works with transfers.  If a person in Cali forget their pills can a pharmacy in OR accept a transfer and fill the pills there or must the patient go through OR's prescription process with a pharmacist?  OR recognizes pharmacists as prescribers for birth control but I'm not sure if they'll recognize out of state pharmacists.  I'm certain that if someone moves or forgets their pills and goes to a state that doesn't have a similar law would not be able to have their prescription transferred.  But then you have Wlgrn's who has their crazy real-time computer system that can get around controlled substance transfer rules, so they throw in another wrinkle.