California hits a milestone: EC offered direct from pharmacies
March 1, 2002 6 minutes read
California hits a milestone: EC offered direct from pharmacies
Golden State second in U.S. to put collaborative protocol into practice
Access to emergency contraception (EC) just got easier in California with the January 2002 implementation of state legislation authorizing pharmacist-administered EC. Now women in that state have another option when the condom breaks or the pill pack doesn’t make it into the suitcase; they can obtain EC directly from the druggist.
California’s Emergency Contraception Pharmacy Program is modeled after the nation’s first pharmacist provider EC program, which was introduced in 1998
For more information on California’s Emergency Contraception Pharmacy Program, contact:
• Pharmacy Access Partnership, 614 Grand Ave., Suite 400, Oakland, CA 94610. Telephone: (510) 272-0150. E-mail: [email protected]. Web: www.EC-Help.org or www.PharmacyAccess.org. in Washington state. More than 30,000 women have obtained EC from Washington pharmacists since that program was initiated. (See the August 1999 issue of Contraceptive Technology Update, p. 85, for an overview of the Washington state project. You can access previous issues of CTU on www.contraceptiveupdate.com.)
The passage of California SB 1169 marks a major milestone in making health services easier to obtain by the women who need them, say those involved in the program. Women are now able to go directly to their pharmacists for EC, which is a significant improvement over having to make an appointment with a doctor or clinic, observes Jane Boggess, PhD, executive director of the Pharmacy Access Partnership in Oakland, which helped to spearhead the EC legislation. (CTU reported on the California initiative in its January 2001 issue; see p. 1.)
Michael Negrete, PharmD, associate vice president of clinical affairs for the Sacramento-based California Pharmacists Association, says, "The real value in having emergency contraception available from pharmacists is that it allows for greatly increased public access to an essential time-sensitive medication regimen."
New law lays groundwork
The California law has three major requirements:
- The pharmacist must initiate EC in accordance with collaborative practice agreements developed by the pharmacist and an authorized prescriber acting within his or her scope of practice.
- Prior to initiating EC, the pharmacist must complete a training program developed by a provider approved by the Chicago-based American Council on Pharmaceutical Education or the Sacramento-based California State Board of Pharmacy.
- The pharmacist must provide each EC recipient with a standardized fact sheet that has been approved by the California State Board of Pharmacy.
Both the California and Washington state EC programs protect a minor’s right to confidential treatment and require that pharmacists report suspected sexual abuse to appropriate authorities.
A variety of training programs is under way to meet California pharmacists’ needs, says Boggess. The state pharmacists’ association sponsors an on-line program (www.calpharm.com/exam/), and the University of Southern California and the association also sponsor four-hour live training programs. The University of California at San Francisco is developing a self-contained two-hour video or DVD program that will be used by some chain pharmacies, she reports.
Boggess says all of these programs contain the following elements: a legal framework for pharmacists initiating EC in California; a clinical overview of EC; counseling skill-building tips; collaborative drug therapy protocols; documentation; and question/answer materials.
Pharmacists join effort
Prior to the passage of the California legislation, demonstration projects were organized to allow local providers to set up collaborative protocols with pharmacists interested in offering EC services. Sites originally were limited to seven California counties: Los Angeles, Marin, San Diego, San Joaquin, San Francisco, San Luis Obispo, and Santa Cruz. Medical providers included local health departments, university student health centers, managed care plans, Planned Parenthood, and other community clinics. Both independent and chain pharmacies were recruited for participation.
Under a liberal interpretation of the then-current law, participating pharmacists were permitted to serve only clients of the authorizing health care facility. Pharmacists directly provided clients with EC and, in most cases, anti-nausea medication. The California Pharmacists Association provided training for pharmacists participating in the program, while the Oakland-based Center for Health Training offered half-day seminars to clinicians and family planning facilities to promote better understanding of EC and encourage consideration of the pharmacy’s role in promoting EC access.
More than 80 pharmacies and health clinics were providing EC under the new program as of mid-January 2002, and more are scheduled to come on board, says Boggess. Organizations such as Planned Parenthood Golden Gate of San Mateo are ahead of the curve when it comes to implementing the new law, since they participated in the demonstration project. Dick Fischer, MD, Planned Parenthood Golden Gate’s associate medical director for obstetrics/gynecology, says he has sent out protocols to area pharmacies, and he has one pharmacy chain with 50 pharmacists signed on for the program.
Due to California’s size and the expense of paid advertisements in the major media markets, the Pharmacy Access Partnership is relying on a "bottom-up" approach to marketing EC access, says Boggess. Consumers and the general public are targeted through collateral dissemination of information through point-of-purchase displays and brochures in pharmacies, as well as through community-based organizations and clinics.
The Partnership maintains a consumer-friendly web site, www.EC-Help.org, which provides information on how to get EC, says Boggess. Another web site, www.PharmacyAccess.org, is maintained for professionals. It provides background information on the state’s EC pharmacy program and offers substantial resources to pharmacists, including several language versions of the required EC fact sheet.
Providers support effort
Most pharmacists have been supportive of the EC program, reports Boggess. However, it is important to understand that in a state such as California, corporate chains own many of the retail pharmacy stores, she notes.
"Some major chains have expressed a commitment to train all of their pharmacists," says Boggess. "Other corporate entities are currently more cautious."
Physician response generally has been favorable once providers understand that major professional associations such as the Washington, DC-based American College of Obstetricians and Gynecologists (ACOG), the Chicago-based American Medical Association, and the Sacramento-based California Medical Association have committed in formal resolutions to over-the-counter status for EC, says Boggess. Pharmacist-initiated EC is a step in that direction, she explains.
Joan Hall, JD, legislative advocate for ACOG’s District IX (California), says, "We are very excited about this legislation and the potential it has to reduce unintended pregnancies." The ACOG District, which represents more than 4,200 practicing California physicians, strongly supported passage of SB 1169.
"ACOG supports changing ECPs from prescription drugs to over-the-counter drugs, because these drugs have a consistently high record of safety," reads the district’s statement on the bill’s implementation. "Until the FDA reclassifies ECPs, SB 1169 will provide an interim solution by making these drugs available through pharmacies that have protocol agreements with physicians."
Open avenues of access
The ability of pharmacists and health care providers to collaborate on EC provision is beneficial, says Negrete. Pharmacists who provide EC represent an important point of access to other reproductive health care resources as they have the opportunity to help a patient determine other needs and facilitate referrals as appropriate, he notes.
Fischer sees the addition of pharmacies as an important step in broadening EC’s access. Many California women do not have a health care provider because they are generally in good health, lack insurance, or don’t know about available publicly funded services. Pharmacies are neighborhood-based, are open at night and on weekends, and are easily accessed by the public, he notes.
"The problem is that when people need emergency contraception, it’s usually at times when doctors’ offices aren’t open," Fischer observes. "We get a lot of our calls after hours Friday night through Monday morning, because that’s the time that people are having sex and that’s when they need it the most, and that’s the time when most doctors’ offices are closed."
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