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In California, Women Can Soon Get Birth Control Without Ever Seeing a Doctor

California will be the first U.S. state where pharmacists can prescribe birth control. Will others follow?

Battling the highest rate of unintended pregnancy in the world, reproductive health advocates in America have pushed for years for letting women get birth control without a prescription. California (and possibly Oregon) is taking one step closer to that.

California passed a law in 2013 that will take effect likely in the coming weeks, once health authorities finalize the procedure for pharmacists to distribute contraception directly. In effect, women will be able to walk up to a pharmacy counter, say they’d like contraception (whether it's the pill or another method), take a short health questionnaire, have their blood pressure taken, get a consultation on dosage and other key pieces of information, and walk out with birth control that very visit. 

The screening protocols, which California’s board of pharmacy established in April, are expected to be officially filed with state regulators soon. Any pharmacist can offer the service.

It’s not exactly over the counter like buying aspirin off the shelf at a CVS, because the pharmacist is still prescribing the contraception. But it's a step toward improving birth control access -- an important part of the Affordable Care Act (ACA), which requires insurers to offer at least one of every form of contraception at no cost to patients.

A study last year in the journal Contraception found providing birth control over the counter could reduce unintended pregnancies by as much as 25 percent. The practice is supported by major medical groups like the American Congress of Obstetricians and Gynecologists.

During the 2014 midterm elections, many Republicans supported OTC birth control, but Democrats argued the GOP's motivation was to free insurers and employers from paying for it, which could happen if it gained over-the-counter status. In the case of California’s law, though, insurers will still cover contraception prescribed by a pharmacist. That helped assauge the concerns of the California Family Health Council.

“We were excited about the opportunity for expanding coverage," said Amy Moy, the vice president of public affairs at the California Family Health Council. "But if there wasn’t a coverage extension and people had to pay out of pocket, that wouldn’t be expansion at all.” 

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Laws like California’s could also help uninsured women because a brief consultation with a pharmacist will likely cost less than an out-of-pocket doctor’s visit for a prescription and take less time.

“We kind of call it ‘behind the counter,’" said Rep. Knute Buehler, a Republican doctor in Oregon who’s sponsoring a similar measure in his state. “A woman wouldn’t have to face that $60 to $100 charge and the hassle of scheduling an appointment.”

Buehler also pointed out that emergency contraception is already available over the counter.

“I just thought there was an inconsistency in that approach, and clearly it’s a best practice in the 21st century for women to have access to over-the-counter birth control.”

But the fate of his bill is uncertain. Buehler calls it a “common-sense” change with no known opposition, but the state’s legislative session ends in mid-July, and his bill might not make it through as it competes with other priorities.  

Moy’s group supports California's pharmacy law, but she's still skeptical about the impact it will have.

“My initial assumption would be that women would continue to go to their provider, whom they trust and they’re currently accessing contraception from, and it would be up to the local pharmacy group to decide how much effort or marketing allocation they’d want to put into this new service,” she said.

Jon Roth, CEO for the California Pharmacists Association, acknowledges consumer awareness will be critical to success there. While major chains will have more resources to market the services, it will take time for the public to recognize the shift in pharamacists' role.

“For many years, pharmacists have just been relegated to being only about the drug product and not for other services," he said. "So it’s a learning curve."

Chris covers health care for GOVERNING. An Ohio native with an interest in education, he set out for New Orleans with Teach For America after finishing a degree at Ohio University’s E.W. Scripps School of Journalism. He later covered government and politics at the Savannah Morning News and its South Carolina paper. He most recently covered North Carolina’s 2013 legislative session for the Associated Press.
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