Dr. Richard Feldman: Allow pharmacists to prescribe self-administered hormonal birth control


Now more than ever, it is imperative to prevent unwanted, unintended pregnancies.

Considering Indiana’s new abortion statute, women should have increased access to birth control measures. Preventing an unwanted pregnancy is far more desirable than addressing the pregnancy after it occurs.

Indiana HB 1568 would allow pharmacists to prescribe self-administered hormonal birth control to women 18 years and older in the form of pills, rings and patches. The bill contains many safeguards, including required training of participating pharmacists and a patient screening protocol and other rulemaking developed in conjunction with the state health commissioner, medical expert consultation and the Indiana Pharmacy and Medical Licensing Boards.

Pharmacist participation is voluntary, and they cannot be forced to prescribe based on moral, ethical or religious objections. The medication must not be an abortifacient. Pharmacists who prescribe for the purposes of abortion would face felony charges.

Additionally, the bipartisan bill’s authors, Reps. Rowray, Negele, Vermilion and Fleming, recognized the importance of the involvement of the patient’s physician or other provider to assure continuity and quality medical care. The bill includes requirements the patient be referred to her provider when the hormonal birth control is prescribed, that a written record of the product be given to the patient with the advice to consult with her provider, that the pharmacist’s prescription is limited to six months and that the patient must see her provider within 12 months of the original prescription.

I anticipate additional safeguards will be added in the rulemaking process.

HB 1568 easily passed in the House. But in the Senate, it entered rough waters. In the Senate Health Committee, although most committee members seemed supportive, the bill faced stiff opposition from two influential Republican lawmakers and a litany of opposing testifiers.

The legislation eventually passed with committee Chairman Charbonneau not accepting any proposed amendments. HB 1568 was then recommitted to the Appropriations Committee, where it also faced continued criticism but also earned committee passage. To my surprise, the bill passed in the full Senate unamended. At the time of this writing, the bill is on its way to the governor for his signature.

Opposition was based on refuting the fact there is a physician (or other women’s health provider) shortage and that pharmacist participation will not actually increase access. Opposition also contended self-administered hormonal contraception is not very effective in preventing unplanned pregnancy and doesn’t necessarily impact infant and maternal mortality or abortion rates. Those objecting further asserted that hormonal birth control is extremely dangerous and that this prescribing is best left to physicians. Their objections are unfounded.

In reality? Indiana has one of highest maternal (third highest) and infant mortality (ninth highest) rates in the country. It has been clearly demonstrated in the public health literature that unplanned/unintended pregnancies are related to increased maternal and infant mortality. When easily available, self-administered hormonal contraception significantly prevents unintended pregnancy. One-third of Indiana counties are federally designated as physician shortage areas and that ”maternity deserts” are widespread. The high prevalence of pharmacies in underserved areas will increase access.

I do not generally support pharmacists providing medical services unless the rationale for doing so is compelling. Providing immunizations and smoking cessation medications are two previous successful examples.

Pharmacists prescribing birth control has been demonstrated in 24 states as very safe when the legislation is thoughtfully written and contains the types of safeguards contained in this bill.

Dr. Richard Feldman is an Indianapolis family physician and the former state health commissioner. Send comments to [email protected].

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