Association of Pharmacist Prescription With Dispensed Duration of Hormonal Contraception

Abstract

IMPORTANCE Since 2016, 11 states have expanded the scope of pharmacists to include direct prescription of hormonal contraception. Dispensing greater than 1 month's supply is associated with improved contraceptive continuation rates and fewer breaks in coverage. Scant data exist on the practice of pharmacist prescription of contraception and its outcomes compared with traditional, clinic-based prescriptions. OBJECTIVETo compare the amount of hormonal contraceptive supply dispensed between pharmacists and clinic-based prescriptions. Prescribing patterns were assessed by describing prescribing practices for women with contraindications to combined hormonal contraception.Characteristics of women seeking hormonal contraception directly from pharmacists were also described. DESIGN, SETTING, AND PARTICIPANTSThis cohort study surveyed women aged 18 to 50 years who presented to pharmacies in California, Colorado, Hawaii, and Oregon for hormonal contraception prescribed by a clinician or a pharmacist between January 30 and November 1, 2019. EXPOSURES Pharmacist or clinic-based prescription of contraception. MAIN OUTCOMES AND MEASURES Months of contraceptive supply dispensed. RESULTS Four hundred ten women (mean [SD] age, 27.1 [7.7] years) were recruited who obtained contraception directly from a pharmacist (n = 144) or by traditional clinician prescription (n = 266).Women obtaining contraception from a pharmacist were significantly younger (82 [56.9%] vs 115 [43.2%] participants aged 18-24 years; P = .03), had less education (38 [26.4%] vs 100 [37.6%] with a bachelor degree; P = .002), and were more likely to be uninsured (16 [11.1%] vs 8 [3.0%] participants; P = .001) compared with women with a prescription from a clinician. Pharmacists were significantly more likely to prescribe a 6-month or greater supply of contraceptives than clinicians (6.9% vs 1.5%, P < .001) and significantly less likely to only prescribe a 1-month supply (42 [29.2%] vs 118 [44.4%] prescriptions; P < .001). Controlling for all covariates, women seen by pharmacists had higher odds of receipt of a 6-month or greater supply of contraceptives compared with those seen by clinicians (odds ratio = 3.55; 95% CI, 1.88-6.70). Pharmacists were as likely as clinicians to prescribe a progestin-only method to women with a potential contraindication to estrogen (n = 60 women; 8 [20.0%] vs 6 [30.0%], P = .52). CONCLUSIONS AND RELEVANCEThese findings suggest that pharmacist prescription of contraception may be associated with improved contraceptive continuation by preventing breaks in coverage through the provision of a greater supply of medication. Efforts are needed to educate prescribing providers on the importance of dispensing 6 months or greater contraceptive supply.

Minnesota Policy on Pharmacist-Prescribed Contraceptives: Benefits, Limitations, and Opportunities for Improvement

“…A study conducted in 2019 reported that pharmacists are more likely to prescribe 6 months or more of contraceptives supply at a time. 39 This practice is supported by the protocol on contraceptive prescribing used in Minnesota, which does not indicate limitations on the number of refills that pharmacists can prescribe. As indicated in the protocol, pharmacists in Minnesota are required to provide the patient with a written record that includes the number of refills approved.…”

“…11 Allowing pharmacists to prescribe 6 months or more of contraceptive supply has the potential to improve contraceptive adherence and decrease unintended pregnancies and should be supported across states' policies. 39 Expanding access through pharmacist-prescribing places Minnesota pharmacists in a position to ensure safety in the prescribing and use of contraceptives. Patients questioned the safety of contraceptives and reported concerns about their adverse events.…”

Opposition to Pharmacist Contraception Services: Evidence for Rebuttal

“…Patients who are able to receive the entire year of contraception in one fill are more likely to continue their method [ 56 ]. Pharmacists more frequently prescribed a 6-month or more supply of contraception at one time compared to other providers in one study [ 57 ]. Pharmacist-prescribed contraception does significantly positively impact access to contraception care.…”

Long-Lasting, Patient-Controlled, Procedure-Free Contraception: A Review of Annovera with a Pharmacist Perspective

“…Receiving healthcare directly from a pharmacist does not require an appointment, and many pharmacies have hours that are expanded from typical medical clinic hours, allowing patients to seek services at times that are convenient for them. Additionally, findings from a recent study show that women receiving contraception from pharmacists were younger, had less education, and were more likely to be uninsured than women seeing traditional healthcare providers [10]. It has also been found that patients who receive a 6 month or greater supply of contraception have higher rates of contraceptive continuation and adherence [6,10].…”

“…Additionally, findings from a recent study show that women receiving contraception from pharmacists were younger, had less education, and were more likely to be uninsured than women seeing traditional healthcare providers [10]. It has also been found that patients who receive a 6 month or greater supply of contraception have higher rates of contraceptive continuation and adherence [6,10]. These findings suggest that the pharmacist prescribing of contraception allows for an improved access to birth control methods, especially in underserved populations, and provides a promising strategy to promote consistent use of contraception [11].…”