HOW IS THIS DIFFERENT FROM OVER - THE - COUNTER CONTRACEPTION ACCESS?

This protocol does not move contraception that currently requires a prescription “over-the-counter”. This protocol allows trained pharmacists to write prescriptions for approved contraceptive methods when it is medically appropriate to do so.

ISN’T A PAP SMEAR OR PELVIC EXAM REQUIRED BEFORE INITIATING HORMONAL CONTRACEPTION?

No, leading medical experts including the World Health Organization and the American College of Obstetricians and Gynecologists state that there is no medical or safety benefit to requiring pelvic examinations, cancer or STI screenings before initiating hormonal contraception. While these preventive and diagnostic services are important in their own right, they do not provide information that is relevant for initiating contraceptive use.

World Health Organization. (2004). Medical Eligibility Criteria for Contraceptive Use. Geneva: World Health Organization. Stewart, F. H., Harper, C. C., Ellertson, C. E., Grimes, D. A., Sawaya, G. F. & Trussell, J. (2001). Clinical breast and pelvic examination requirements for hormonal contraception: Current practice vs. evidence. JAMA, 285(17), 2232-2239. http://doi.org/10.1001/jama.285.17.2232

WILL INSURANCE PAY FOR PHARMACISTS' CONSULTING TIME IN PROVIDING CONTRACEPTION?

Work is ongoing to ensure that pharmacists are reimbursed appropriately by insurance companies for the visits associated with prescribing and administering medications for all existing pharmacy protocols in New Mexico. Currently, some pharmacies have been charging a cash fee for consultation services which varies from pharmacist to pharmacist.

HOW DOES THE CONTRACEPTION PROTOCOL FIT IN WITH EXISTING PHARMACIST RESPONSIBILITIES?

There are several existing protocols that allow trained pharmacists to prescribe and administer medications in New Mexico, including vaccinations, tobacco cessation products, the opioid overdose treatment product Naloxone, and TB testing.

HOW MIGHT PRIVATE CONTRACEPTION CONSULTS WORK WITHIN BUSY PHARMACIES?

Many pharmacies are already engaged in activities such as administration of vaccines and have private consultation areas where conversation and counseling can take place. Notably, the physical examination requirements for this prescription protocol are limited to a blood pressure measurement. Sometimes if a patient is too embarrassed or unwilling to schedule a formal appointment, the counter is a place where the patient may feel comfortable having such a conversation.

WOULD THIS PROTOCOL BE LIMITED TO ORAL CONTRACEPTION?

No, there is no sound medical reason for limiting the protocol to pills and leaving out other methods with similar hormonal formulations like patches and rings, for example. The U.S. Medical Eligibility Criteria (US MEC), the gold standard of evidence based contraceptive care, clearly defines safety and medical eligibility for all hormonal methods covered by the protocol.

Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., et al. (2016). U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR, 65(3), 1-104. http://doi.org/10.15585/mmwr.rr6503a1

WILL THIS PROTOCOL KEEP PATIENTS FROM ACCESSING LONG-ACTING METHODS, LIKE IUDS?

No, the protocol requires pharmacists to provide resources and referrals to patients requesting more information or access to long-acting reversible contraceptive (LARC) methods. It is important to remember that LARC methods are not right for everyone. Standards of care require that family planning be patient-centered and responsive to individual preferences, needs, and values.

DOES THIS PROTOCOL ADDRESS SEXUALLY TRANSMITTED INFECTIONS?

Yes, sexually transmitted infection (STI) education and counseling is an essential part of reproductive healthcare and is included in the contraception protocol. Pharmacists will refer patients for STI screenings when requested.

WILL PATIENTS STOP GOING TO OTHER PROVIDERS FOR IMPORTANT PREVENTIVE HEALTH CARE IF THEY’RE ABLE TO GET THEIR BIRTH CONTROL AT A PHARMACY?

No, research suggests that individuals continue to see their health care providers for other preventive services at high rates even when they are able to access contraception through the pharmacy. Requiring individuals to receive unrelated services in order to obtain contraception raises ethical concerns and creates harmful barriers to care.

This protocol requires pharmacists to refer patients to other providers or a local clinic if they have medical risk factors that make them ineligible under the protocol, are experiencing side effects, or are seeking methods not provided at a pharmacy. Pharmacy access to contraception allows pharmacists an opportunity to engage patients and provide them with information about the importance of other preventive health care.

Hopkins, K., Grossman, D. White, K., Amastae, J., & Potter, J. E. (2012). Reproductive health preventive screening among clinic vs. over-the-counter oral contraceptive users. Contraception, 86(4), 376-82. http://doi.org/10.1016/j.contraception.2012.03.003