March 7, 2017

Should pharmacists prescribe birth control pills?

JEFFERSON CITY -- The sponsor of legislation that would allow pharmacists to prescribe birth control pills says his bill is both pro-choice and pro-life.

"Itís pro-choice in the sense that we are trying to give women more control over their reproductive health and over their family planning, and itís pro-life in the sense that the bill is intended to reduce unintended pregnancies and abortions," said Ballwin Republican Shamed Dogan.

He said House Bill 233 could help reduce Missouriís unplanned pregnancy rate by as much as 25-percent.

HB 233 would let pharmacists prescribe oral contraceptives to those 18 or older regardless of whether that person has a previous prescription. Those younger than 18 who have evidence of a previous prescription could also be prescribed the pill by a pharmacist.

The legislation is projected to save Missouri money, and Dogan said it would save women money and time by negating the need for some visits to their doctor.

Several groups testified in favor of the bill, including the Teen Pregnancy and Prevention Partnership. Its Executive Director Meg Boyko said HB 233, "would just be one step in the right direction to lowering barriers to access to care to those teens so they can take responsibility of their health and their health outcomes and prevent teen pregnancy."

Representative Cora Faith Walker (D-Ferguson) said a similar plan in California didnít have the results backers hoped it would.

"This is just a different barrier. By making it behind the counter, making it a requirement for pharmacists to write the prescription, it just kind of shifts the barrier," said Walker.

"Weíre a different state than California," Dogan responded. "I think one of the issues that we might have that they donít face nearly as much is rural folks Ö I think the fact that many people in rural areas donít have access to a doctor in the same way that they have a lot more pharmacists in their areas Ö Yeah thereís still somewhat of a barrier, but itís not nearly what the barrier is right now."

Dogan said he favors making birth control over-the-counter, but noted such proposals have not been adopted in states that are more politically progressive than Missouri, and he doesnít feel such a bill would be likely to pass in the Missouri legislature.

Shannon Cooper testified against HB 233 on behalf of Blue Cross/Blue Shield and the Missouri Coalition. He said their primary concern was that without the need for a prescription, women would make fewer visits to their doctors.

"Under the [Affordable Care Act] and insurance policies, we provide a free exam once a year and we feel like for a lot of the invincibles that we talk about who donít think theyíre ever going to be ill or have any problems, when they receive these birth control pills and the prescriptions that does drive them back to the physician to get that exam," said Cooper. "I think we all know that early detection of any type of disease is one of the best cures for that disease."

Cooper also expressed concern that HB 233 would allow up to a 12-month supply of birth control pills to be prescribed under certain circumstances.

"We feel like there will be certain individuals who could take advantage, get that supply and then drop off our policies with that 12-month supply," said Cooper. "Obviously thereís a cost concern there."

Others expressed concern that allowing a 12-month supply could lead to wasted pills, such as in cases in which a woman only uses them for a while and then stops for some reason.

Representative Mike Stephens (R-Bolivar), himself a pharmacist, said he hopes the proposal represents a larger effort to expand the availability of medical services.

"If there is a saving grace to the health care system it must include a greatly expanded role in health care delivery and health care access by a wide variety of health care professionals," said Stephens.

The committee has not voted on HB 233.

Last year similar legislation was passed by the House 97-50, but stalled in the state Senate.