Pharmacists’ refusals prompt legislation
By Cynthia Dailard
Senior Public Policy Associate
The Alan Guttmacher Institute
Washington, DC
Legislators across the nation are grappling with the contentious issue of whether pharmacists have the right to refuse to fill birth control prescriptions on moral or religious grounds — and in turn the obligation of pharmacies to meet the needs of consumers seeking to avoid unintended pregnancies if and when pharmacists refuse.
The issue of pharmacists refusing to fill birth control prescriptions is not new; in fact, the American Pharmaceutical Association (APhA) adopted a policy as early as 1998 which "recognizes the individual pharmacist’s right to exercise conscientious refusal and supports the establishment of systems to ensure patient access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal." However the increasing demand for the time-sensitive emergency contraception (which is most effective in preventing pregnancy when taken within 72 hours after unprotected sex) and ongoing efforts by many anti-abortion activists to mischaracterize the drug as an abortifacient has helped bolster a movement to give pharmacists the right to refuse to fill birth control prescriptions while ignoring consumers’ needs.
Clearly, these efforts are making headway. Currently, four states have laws that explicitly allow pharmacists to refuse to dispense contraception: Arkansas, Georgia, Mississippi, and South Dakota. [When Mississippi Gov. Haley Barbor signed his state’s bill into law in April 2004, he hailed it as "the single most expansive conscience exception law in the nation."] And incidents of pharmacists refusing to fill prescriptions for birth control have been documented in more than a dozen states. In some of these cases, pharmacists have gone to such extreme lengths as refusing to refer the prescription to another pharmacy or even returning it to the woman so she could take it elsewhere. Women also have reported being lectured by pharmacists about their religious beliefs and chastised for being "irresponsible."
Illinois became the first state to address the problem from the consumers’ perspective when Gov. Rod Blagojevich in April issued an emergency regulation in response to pharmacists refusing to fill the prescriptions of two Chicago women for emergency contraception. The Illinois rule requires pharmacies to fill a valid prescription for a contraceptive "without delay" pharmacies violating the law could lose their license. The rule also establishes a toll-free hotline for state residents to report refusals. According to the governor, "Pharmacists and pharmacies should not stand in the way of a doctor’s decision on how to best treat a patient. And pharmacists should not be in a position to deny a woman access to health care simply because they disagree with the decision she and her doctor made."
Three pharmacists, however, have filed lawsuits alleging that the rule violates their rights under state law by requiring them to violate their ethical and religious beliefs. In response, the governor’s spokesperson has stated, "They’ve chosen to be in the field of providing contraceptives. They don’t have the right to pick and choose who they’re going to serve."
Look for more action
This year, legislators in five other states introduced legislation that would require pharmacies or pharmacists to fill prescriptions for contraceptives or otherwise accommodate consumers. These states include California, Missouri, Nevada, New Jersey, and West Virginia. In June, the governor of Nevada signed legislation to require a pharmacist who refuses to fill a legal, valid prescription on moral or religious grounds to transfer it to another pharmacy. In April, a pharmacist in Wisconsin was disciplined by the state’s pharmacy examining board for refusing to fill a prescription for birth control pills.
In addition to this state activity, a handful of legislators have introduced bills in Congress as well. The "Pharmacy Consumer Protection Act" introduced by Sen. Barbara Boxer (D-CA), would require pharmacies accepting Medicare and Medicaid funding to fill all valid prescriptions "without unnecessary delay or other interference, consistent with the normal time frame for filing prescriptions."
The "Access to Legal Pharmaceuticals Act," introduced by Sen. Frank Lautenberg (D-NJ) and Rep. Carolyn Maloney (D-NY), adopts a somewhat different approach by laying out the duties of pharmacies to consumers when individual pharmacists refuse to fill valid prescriptions. According to the bill’s sponsors, the bill "seeks to strike a careful balance" by allowing an individual pharmacist to refuse on moral or religious grounds to dispense contraception, but requiring the pharmacy to ensure that the prescription is filled in a timely manner. Relatively similar legislation also was introduced by Rep. Carolyn McCarthy (D-NY).
Given the composition of Congress and that many state legislatures have adjourned for the year, further legislative activity on this issue is unlikely in the coming months. However, there is every indication that the issue will continue to gather steam in the states next year, particularly if the media and family planning advocates continue to shine a spotlight on reported incidents of pharmacists refusing to fill birth control prescriptions.
Legislators across the nation are grappling with the contentious issue of whether pharmacists have the right to refuse to fill birth control prescriptions on moral or religious grounds and in turn the obligation of pharmacies to meet the needs of consumers seeking to avoid unintended pregnancies if and when pharmacists refuse.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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