Typically, there have been many steps to getting contraception: Scheduling a doctor’s appointment and waiting what can often be months until the next available appointment. Arranging for time off work, transportation and even child care to make it to the appointment just to get a prescription for birth control.
Then there’s going to a pharmacy to pick up the medication.
It doesn’t have to be this way anymore.
Now, people can walk into pharmacies without a prescription and walk out the same day with birth control in hand. For Medicaid enrollees, the medication comes at no cost.
Several recent changes have allowed pharmacies to play a larger role in reproductive health care access. That’s important since contraception has become a key consideration amid increased restrictions on abortion, said Mollie Ashe Scott, regional associate dean at the UNC Chapel Hill Eshelman School of Pharmacy.
Pharmacists in North Carolina were granted the ability to provide hormonal contraceptives without a medical provider’s prescription when a new law, House Bill 96, took effect on Feb. 1, 2022. Since then, more than 330 pharmacies have stepped up to provide contraception services in 92 counties.
The first over-the-counter birth control pill available in the United States — Opill — also hit store shelves earlier this year. The option marked a significant shift in how to obtain contraception by eliminating the need for a prescription.
Last week, Opill became even more accessible when NC Medicaid began covering the cost of the over-the-counter oral contraception in pharmacies across North Carolina. This means that the pill, which retails for $20 for a one-month supply, will be available at no cost to Medicaid beneficiaries.
NC Medicaid also pays for pharmacist-initiated contraceptive counseling services at pharmacies.
“By increasing access to contraception, we can improve maternal and infant health,” Elizabeth Cuervo Tilson, state health director, said while standing with Gov. Roy Cooper in a Walgreens pharmacy in Chapel Hill on July 31.
To find a pharmacy providing pharmacist-initiated contraceptive services in North Carolina, visit ncpharmacyfinder.com. You can also call your pharmacy to ask if they offer the service.
Combating contraceptive deserts
Annual surveys by the state Department of Health and Human Services show that more than four in 10 pregnancies in North Carolina are unintended. Tilson said that access to contraception is key to preventing these types of pregnancies, which can result in poorer outcomes for mothers and babies.
In North Carolina, 637,960 women with low income live in areas that can be classified as “contraceptive deserts,” according to data from the nationwide pregnancy prevention advocacy group Power to Decide. A contraceptive desert is a county or area that lacks reasonable access to a health center that offers the full range of contraceptive methods, such as a gynecologist’s office or a community health clinic.
Scott said pharmacies have the potential to fill critical gaps in contraceptive access since almost 90 percent of the U.S. population lives within five miles of a community pharmacy.
Early analysis of the patients served by some of the first pharmacies to roll out pharmacist-initiated contraception shows that’s already happening, Scott said. She said that almost 40 percent of people using the service said they didn’t have a primary care doctor to obtain a prescription from.
Scott added that others accessing contraception at pharmacies were out of refills on a contraceptive method, and the pharmacist was able to renew the prescription to prevent a gap in care.
Research looking at patient experiences in California showed people may opt to get contraception at pharmacies because they are nearby and have extended hours. Three-quarters of respondents said they went to the pharmacy because it was faster than getting an appointment.
In rural areas where there are fewer providers, pharmacy access can be particularly beneficial, Scott said. She added that’s a motivating factor for many of the pharmacists who offer the new service.
“I think the ‘why’ remains trying to improve women's health in this era post-Roe — that patients have health care needs that we can meet,” Scott said. “Community pharmacists are seeing the challenges of not having enough providers within their rural communities, and so, knowing that, they can step in and help folks with this health care need.”
New access
While pharmacists still expect doctor’s offices to be the main way people access birth control, they know that providing it in pharmacies will help reach more people.
“There are so many pieces of getting contraceptives: going to a doctor, getting insurance to pay for it, going to the pharmacy to get it,” said Jessica Hudak, a fourth-year pharmacy student at the UNC Eshelman School of Pharmacy, who’s been researching pharmacist-initiated contraception. “We can streamline that and get them directly to the pharmacist — and they can even pick up their prescription the same day.”
She hopes to be able to prescribe contraception herself as a pharmacist to make it more accessible where she ends up practicing.
Hudak’s seen the effects of contraception being out of reach in her small hometown of Moyock in Currituck County — one of the most eastern counties in the state. She said many of the people she went to school with — including one of her best friends — had unintended pregnancies.
Fortunately, Hudak said, her own mom was proactive, and she got her health care needs addressed in Virginia, over the border from Currituck County. But she can’t help but think about what it would have meant for the community to have more options for contraception closer to home.
That’s why she’s so encouraged about the new abilities of pharmacists to prescribe contraception and stock the over-the-counter Opill to address gaps in communities across the state.
With a new independent community pharmacy poised to open soon in her hometown, Hudak sees the implementation of pharmacist-initiated contraception as one way to improve access. And she said she’ll be ready to make the pitch.
“I'm so ready for those doors to open up,” Hudak said. “I will walk in there with some paperwork and some notes, and I'll say, ‘What are you guys gonna do for our young ladies?’ And I’ll see what they have to say,” Hudak said. “And then I'll say, ‘How can I help?’”
Expanding awareness
While pharmacist-prescribed contraception is not yet widespread, Scott, who is helping lead implementation across the state, said the number of pharmacists who’ve completed the training to dispense birth control and are rolling out the service is continuing to grow.
“We haven't plateaued,” Scott said. “We'll continue to build those relationships and provide support to help pharmacies provide this very important service.”
Scott said several chains, such as Walmart, Ingles and Walgreens, are slowly onboarding their pharmacies across the state.
The eight counties that do not have any pharmacies offering contraception services are concentrated in the northeastern part of the state. Scott said she’s engaging in targeted efforts to encourage pharmacists to come on board in those communities.
As more pharmacists implement contraception services, Scott said she’s also working to make sure consumers know contraception is available at pharmacies without a prescription — Opill, other hormonal pills and patches — at participating pharmacies. A marketing campaign launching in September will help spread the word on available options, she said.
“It's a whole new world with contraception,” Scott said. “It's really changed in terms of the way that the pharmacist can provide contraception to increase access to care.”
Anne Blythe contributed reporting.
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.