Some women in Illinois may soon find it easier to skip visits to their doctors and instead cross the border for their birth control.
A new bill proposed in Missouri would allow licensed pharmacists to prescribe birth control pills and hormonal patches without a separate visit to a doctor. These drugs still require a prescription, even though many medical professionals – including the American College of Obstetricians and Gynecologists – believe they should be available over the counter without a prescription. If the Missouri law passes, it will eliminate an unnecessary regulatory hurdle that can increase costs, force women to take time off work for a doctor’s appointment, and may prevent some women from using birth control.
Beyond the convenience and health benefits the measure would afford women, the bill’s author, pro-life Missouri state Rep. Sheila Solon, R-Blue Springs, supports the bill because it could help reduce unintended pregnancy.
California and Oregon already have similar laws, and several other states are currently considering legislation along these lines. The proposed law does not eliminate the prescription requirement, make pills or patches available over the counter, or change who can receive birth control. Instead a licensed pharmacist would be able to prescribe pills or patches after a medical screening. And pharmacists can still refer women to a doctor if they believe it is appropriate.
Like some other states, the Missouri bill requires patients under 18 years old to first visit a doctor. It also requires a woman to visit a doctor within three years of the initial prescription, addressing a concern that some women would not receive regular cancer screenings if they do not need to visit a doctor to obtain birth control.
Requiring doctors’ visits can significantly reduce the likelihood of women’s receiving birth control, especially when they lack financial means. One study, which looked predominantly at low-income and uninsured women, found that when women need a doctor’s prescription, they are 60 percent more likely to stop taking birth control.
Allowing pharmacists to prescribe birth control in Illinois would remove an unnecessary regulatory hurdle – but there are many other hurdles that may reduce access to health care, especially in the state’s low-income and rural areas. The White House has noted that “excessively stringent restrictions on practitioners’ scope of practice” increase the cost of health care and other services and reduce accessibility.
Several states have moved to address these problems. Tennessee has assembled a task force to identify opportunities to change scope-of-practice laws to “improve ‘Tennessee residents’ health by providing access to quality and cost effective care.’” Tennessee is also one of the states considering allowing pharmacists to prescribe birth control. In Washington state, pharmacists can prescribe medications including antihistamines, antibiotics and birth control, but only under a doctor’s supervision. In December, Ohio passed a new law expanding pharmacists’ ability to provide patient services under doctor supervision.
Allowing physician assistants, nurse practitioners and pharmacists to provide basic services under a doctor’s supervision can reduce cost and improve access to health care. But “collaborative practice agreements” can be bureaucratic and thus reduce the overall benefits. The White House advocates allowing physician assistants and nurse practitioners to practice and write prescriptions without physician supervision. Studies indicate that these measures can not only significantly reduce the cost of care but also improve access, especially in low-income and rural areas. Expanding pharmacists’ ability to provide primary care services would likely have the same effect.
So far, Illinois has made limited progress in this field. Illinois is one of only six states that do not allow collaborative-practice agreements for pharmacists. Last year, the Illinois General Assembly passed a new law that allows nurse practitioners to operate without physician supervision, thus improving nurse practitioners’ ability to reach underserved communities. But the law also imposes new licensing provisions that make it harder to become a nurse practitioner. Unfortunately, studies suggest increased licensing requirements limit the benefit from eliminating doctor-supervision restrictions and don’t necessarily improve quality of care.
There is still much policymakers in Illinois can do to reduce the cost of care and make medical services more available. Allowing pharmacists to prescribe birth control would be a small step in this direction, but an important one for many women in the state. Ultimately, expanding scope of practice for medical practitioners will benefit the poorest and most rural areas of the state the most.