Oregon is poised to enact a measure allowing pharmacists to write and fill prescriptions for hormonal birth control, including the pill and the patch. The bill, which has been winding its way through the legislature since February but cleared its final House vote this week, isn’t quite the same as over-the-counter birth control—an issue that has become de rigueur in Congress—but it’s still a groundbreaking bit of policy.
California passed a similar measure last month, but it hasn’t been fully implemented. If Gov. Kate Brown signs HB 2879, which she’s expected to do, Oregon could be the first to put the law into practice. That would make the state something of a policy laboratory as the issue of expanding access to birth control gains support across political lines. (Even if some of that support looks more like political theater than an actual investment in reproductive health, but, you know, details.)
From the bill:
In accordance with rules adopted by the State Board of Pharmacy under ORS 689.205, a pharmacist may prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives to a person who is:
(a) At least 18 years of age, regardless of whether the person has evidence of a previous prescription from a primary care practitioner or women’s health care practitioner for a hormonal contraceptive patch or self-administered oral hormonal contraceptive; or
(b) Under 18 years of age, only if the person has evidence of a previous prescription from a primary care practitioner or women’s health care practitioner for a hormonal contraceptive patch or self-administered oral hormonal contraceptive.
The idea of letting pharmacists prescribe birth control was first introduced by Republican state Rep. Knute Buehler, who sounds super chill about the whole thing.
“Improving access to birth control will give women more options and more control over their health care needs,” Buehler said back in April. “As a doctor, I believe birth control should be as easy and accessible as possible. If a woman wants to purchase birth control at her local pharmacy, she should be able to do that without having to schedule an appointment with a doctor.”
While the Oregon bill isn’t the same thing as over the counter-birth-control—that means lifting the requirement for a prescription altogether—it offers similar benefits. The American Congress of Obstetricians and Gynecologists endorsed the idea back in 2012, citing the safety of the pill, interest among pharmacists and research showing that more women say they would use birth control if they could get it over the counter.
But there are still some issues on the horizon if OTC birth control or pharmacist-prescribed contraception takes off nationally—like the fact that pharmacists can tell you "no" if you ask them for birth control. A patchwork of conscience and refusal clauses mean that pharmacists can opt-out of filling prescriptions for things like Plan B or other contraceptives if they have religious objections.
Oregon requires pharmacists who refuse to fill prescriptions to ensure that their customer still receives the medication from somewhere else, but refusal clauses could put the pill out of reach for some. (Finding another pharmacy may not be a problem in a city like Manhattan where the concept of convenience leans toward the absurd—there is a block in Midtown with two stores from the same pharmacy chain directly across the street from one another—but this is hardly the case everywhere.)
And while the Oregon measure ensures that insurance companies cover birth control prescribed by a pharmacist, people without insurance are still going to struggle to afford a prescription—cutting out a visit to the doctor may reduce costs, but contraception can be prohibitively expensive for low-income women.
Expanding access to pharmacies also won’t do much to drive down costs, no matter what some members of Congress are currently saying about free markets and competition. And if you want an IUD, you're still going to need a doctor to insert it.
But letting pharmacists write their own prescriptions for the pill and the patch is still a major development in the push to expand access. While measures on OTC birth control work their way through Congress, people in Oregon might soon be able to walk into their corner pharmacy, chat with the person behind the counter, and walk out with a 12-month supply of birth control. Imagine that.