Colorado pharmacists soon can begin prescribing oral contraceptives under a new protocol that will provide unprecedented access to birth control in this state.
Women who are at least 18 can complete a questionnaire, blood-pressure check and a 10- to 15-minute consultation with a pharmacist, then walk out with birth-control pills or patches, under new rules set in motion by a 2016 state law with bipartisan support. Colorado is just the third state with such access, joining Oregon and California.
The law, passed last year, allowed the boards of medicine, nursing and pharmacy, along with the state health department, to create protocols for pharmacists to provide services that tackle public health needs. At the top of the list, based on a survey of medical professionals, was hormonal contraception.
Pharmacies throughout the state are preparing to offer the service as soon as April, and those on or near college campuses are anticipating its popularity among young women.
College students often are seeking birth control for the first time and will put it off because of the daunting requirement of first scheduling and waiting for a doctor’s appointment and pelvic exam, health professionals said. And for some young women whose physicians are back in their hometown, running out of refills while away at college means a gap in protection from unwanted pregnancy.
“People could be coming in to buy shampoo or vitamins, and they can have that conversation with a pharmacist,” said pharmacist Kelsey Schwander, who is doing a residency at Good Day Pharmacy near Colorado State University in Fort Collins.
Besides college students, Schwander expects that people living in rural areas five or 10 miles out of town will access birth control at the pharmacy. “These are high-risk populations for unwanted pregnancy,” she said.
The American Congress of Obstetricians and Gynecologists endorsed making oral contraceptives available over the counter in 2012, saying women were able to “self-screen” for problems and that seeing a doctor was an unnecessary obstacle for most women. A University of California at San Francisco study found that unintended pregnancies could be reduced by up to 25 percent if oral contraception was available over the counter.
“Easier access to contraception is expected to decrease the rate of unintended pregnancies in our state,” said pharmacist Gina Moore, an assistant dean at the University of Colorado Skaggs School of Pharmacy and part of a task force that created the new protocol.
A one-page questionnaire asks about the possibility of pregnancy, as well as history of smoking, migraine headaches, high blood pressure, stroke and breast cancer — all issues that could preclude a woman from taking oral contraceptives. An estimated 10 percent of women will be referred to a doctor, based on the screening, Moore said.
The rules in Colorado require a woman taking birth-control pills to see a doctor for a medical exam at least once every three years. That means a woman could receive pills or the patch without ever seeing a doctor, but would need a medical exam within three years in order to continue the prescription.
Whether birth control is prescribed in a pharmacy or doctor’s office is not expected to affect insurance coverage of the pill.
Pharmacists on the University of Colorado at Boulder campus intend to start a pilot program this summer and a full rollout in the fall, said Sue Mead, director of pharmacy at The Apothecary at CU-Boulder. After providing birth-control pills, pharmacists will refer students who don’t have a doctor to the women’s health center on campus.
“This doesn’t eliminate their need to see a health-care provider,” Mead said.
Still, some health-care providers are concerned about patient safety, including Dede Chism, a nurse practitioner and director of Bella Natural Women’s Care, a women’s health clinic that teaches natural birth-control methods. The clinic sees women daily who are experiencing side effects of birth control, from the more minor issues of acne, headaches and fatigue, to more serious ones, including depression, anxiety and blood clots, Chism said.
“Pharmacists are excellent in medication, but they are not trained in care for the patient at the bedside,” she said. “It just seems like taking the health-care professional out of that is kind of a dangerous step.”
State rules don’t require pharmacists to participate, including those who have moral or ethical objections. No one testified against the legislation as it passed through Senate and House committees last year. The Archdiocese of Denver declined to comment for this story.
In a state health department survey of 2,656 physicians, nurses, pharmacists and other health professionals, hormonal contraception ranked as the first priority among the health issues pharmacists could handle through the new state process set up by the law. Second was tobacco cessation, followed by testing for the flu. Pharmacists soon will start prescribing medication to quit smoking, although the policy and training program is still in progress.
Concerns identified by survey respondents involved liability and training of pharmacists, further fragmentation of patient care and workload for pharmacists. Pharmacists, who typically have seven or eight years of college, must have liability insurance, go through state-certified training and inform the patient’s primary-care doctor when they prescribe birth-control pills, under the rules.
Girls under 18 are not eligible, in part because the American Academy of Pediatrics recommends adolescents consult with their doctor and “work through these questions in a secure environment,” according to state policy.
