State of Washington increases access to contraceptives
Dariel Weaver
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Health officials in Washington state are considering allowing pharmacists to provide prescription contraception, including birth control pills, patches and vaginal rings, to women without a doctor's visit. Instead of seeing a physician every year for a pelvic exam, women will be able to complete a 23-item "good health" checklist with their pharmacists to get contraception.
Washington was the first state to legalize abortion through a popular vote and the first to allow emergency contraception without a doctor's prescription. Currently the University of Washington School of Pharmacy and Department of Obstetrics and Gynecology is conducting a study in the Seattle area to see how comfortable doctors and patients would be with the change.
Pharmacists at eight participating Fred Meyer or Bartell pharmacies undergo an eight-hour training session and operate under doctor-approved guidelines to ensure that women receiving contraception will not suffer adverse health consequences or drug interactions. Women with high blood pressure, a history of breast cancer or blood clots and women who are obese or smoke heavily are screened out due to health risks.
The cost is $25 per pharmacy visit plus the cost of medication. Though many insurance plans do not cover contraception, and most will not cover the cost of the visit, the overall price is far lower than a yearly pelvic exam in a doctor's office.
Pharmacists report many interested phone calls about the study, indicating support among women for the new guidelines. The move is intended to allow greater access to contraception for women who cannot afford yearly exams, which are only sporadically covered by insurance companies and Medicare.
"The pharmacists were feeling frustrated when a woman came in for emergency contraception and they gave it to her, they would say, `What do you plan to use?' and lots of times they didn't have a prescriber or a method in mind," said Jacqueline Gardner, whose team at the UW School of Pharmacy led the initiative to lift restrictions on emergency contraception.
Health care workers, family planning experts and population control specialists have all expressed enthusiastic support for the idea of abolishing the doctor's visit requirement. "Anything that is expanding access to people where and when they need it is a positive thing," said Robert Harkins of Planned Parenthood of Western Washington.
Pharmacist Don Downing, another researcher on the project, said that the change represents a step towards more convenient, as well as more affordable, contraception, especially for women who need birth control but do not have doctors because of a recent move or work hours that make it difficult to get to a doctor's office. "Pharmacies don't have tables with stirrups on them and I think that's a bonus, and we're available after hours and weekends when most clinics are not open," Downing said.
Many gynecologists have long argued that, while yearly exams are necessary to check for sexually transmitted diseases and cervical cancer, they are not important for prescribing contraceptives. Opponents of the program say that making contraception more readily available will lead to a decrease in yearly checkups and exams, but the majority of health care specialists agree that the change is a good thing.
"I think personally the positives probably outweigh the negatives for women," said Elisabeth Evans, an obstetrician-gynecologist at Overlake Hospital Medical Center in Bellevue. "I think it's hard for women to always go to the doctor to get a prescription for something that's probably safer than aspirin."