Pilot Program Tests Distributing Emergency Contraception Without a Prescription

Women in eight California counties can now obtain emergency contraception without a prescription through a new pilot program launched by a public health coalition, the Los Angeles Times reports. Under the program, numerous community clinics are providing women "who might want the drug" with a card referring them to a participating pharmacy. Before receiving the drug, a woman must complete "encounter forms," which include questions about her sexual history, and must participate in a counseling session with the pharmacist. The pharmacy also must notify the appropriate clinic after the woman receives the pills. So far, the pharmacies are primarily distributing Plan B, a pill that is more costly than its competitor Preven but has "fewer side effects." The pilot effort, funded by a $2.2 million grant from the David and Lucile Packard Foundation, is being led by the Pharmacy Access Partnership, a coalition of public health advocates and academics. No "legal objections" to the program have been raised thus far, and similar pilot programs are being considered in Oregon and Alaska.

The Times reports that pharmacists "strongly support" the pilot program, viewing it as a way to "expand their role as health care providers." The California Pharmacists Association is holding workshops for pharmacists who want to distribute EC, including sessions on "sensitivity training" that will address how to discuss the drug with women seeking it. However, some lawmakers and physicians feel that pharmacists should not be licensed to dispense the drug without a physician referral. Steven Thompson of the California Medical Association said that pharmacists "are pushing the envelope" under the new program, adding that although state law allows doctors to "delegate their authority to pharmacists for specific patients," it does not allow that authority to extend to larger groups, such as the "thousands" of women using community clinics. Thompson added that the law applies only to "adjustments" of medications, not to new prescriptions. CMA CEO Jack Lewin said, "We support an over-the-counter approach, but we do not support pharmacies initiating prescriptions. ... It is a very clever idea, but it seems there is a loophole." Some lawmakers are also wary of the program. To prevent minors from obtaining EC, the San Bernardino County Board of Supervisors is seeking a federal waiver to ban the drug from county-run clinics. San Bernardino County is not participating in the pilot program.

While OTC distribution may increase women's access to EC, prescription sales of the drug are "too low to support a switch to OTC status," according to Gynetics, Preven's manufacturer. Because OTC products must "compete" for shelf space based on sales volume, EC pills would be vying for space with popular products such as Tylenol. In addition, Medi-Cal does not cover the drug, making access difficult for low-income women and teens, who could pay between $35 and $70 out of pocket for the pills and counseling. CPA Vice President Elizabeth Johnson said that the state is "working on" the cost issue. Family PACT, a state health plan for low-income people who do not qualify for Medi-Cal, has agreed to help some women purchase Plan B with state funds. Meanwhile, the Pharmacy Access Partnership is paying pharmacists $15 per woman to cover counseling fees (Gellene, Los Angeles Times, 4/11