Video Transcript: Innovative State Approaches to Pharmacist-Prescribed Contraception
Video Transcript: Innovative State Approaches to Pharmacist-Prescribed Contraception SOPHIA DURANT: Hello, everyone! Welcome! I'm showing one past the hour, so we're going to be getting started. So welcome to this webinar! It's hosted by the Implementing Pharmacists Prescribed Contraception Learning Community. My name is Sophia Durant, I'm a Senior Analyst of Family and Child Health at the Association of State and Territorial Health Officials, or ASTHO. A few brief housekeeping items. This webinar will be recorded and be made publicly available on ASTHO's website. The recording and slides will also be emailed out to all registered participants within a week or two. For those of you who aren't familiar with ASHO's work in this space, ASHO kicked off an implementing pharmacists' prescribed contraception Learning Community in April of this year. This learning community is really focused on technical support and capacity building for a group of four jurisdictions as they develop sustainable strategies for pharmacist-prescribed contraception implementation. This includes really thinking about how do we build workforce capacity, what does reimbursement look like in a sustainable way, and what does patient awareness look like. A big focus of our project is really bringing together stakeholders from the pharmacy field, and also the sexual and reproductive health partners. And with this grant, we produce publicly available materials, like this webinar, to promote improved public health through advanced contraception access. And if you're interested in learning more on this project, feel free to send us an email at contraceptionaccess at astho.org. And we will be putting that email in the chat as well. I wanted to review, what we're going to be spending our time on today. So, I'll be doing a brief overview from a national perspective about pharmacists prescribed contraception, and look at some key policy and implementation trends. And then I'll be facilitating a roundtable discussion, with our panelists about each of their own state's approach to implementing pharmacist-prescribed contraception, and what sort of innovative strategies that they've been using. And we'll also be holding a bit of time at the end of our discussion with panelists for a Q&A from the audience. So, with that being said, I am going to jump into just a quick level set, so we're all coming into this discussion with a little bit of a shared understanding of pharmacist prescribed contraception, or PPC. PPC refers to a policy approach that allows pharmacists to assess a patient and directly provide contraception, without the patient first needing a prescription from another clinician. In other words, the pharmacy becomes an access point both for assessment and direct access to contraception. And this matters because pharmacies tend to be more accessible than clinics. Most Americans live within 5 miles of a pharmacy, so pharmacists prescribed contraception leverages a place people already go to expand access to contraception. And this access point is especially critical now. Federal and state actions have taken steps that limit or remove sexual health services for many communities. And even before the current political climate, access barriers for contraception were incredibly common. One study found that 29% of women who tried to obtain hormonal contraception encountered difficulties getting an initial prescription or refills. And this study specifically refers to accessing contraception through a healthcare provider, like a primary care doctor or an OBGYN. We also know that structural disparities remain. throughout public health, but especially around contraception access. So, some communities face far steeper hurdles in accessing contraception, and one recent Kaiser Family Foundation analysis found that 3.8 million women of reproductive age with incomes under the federal poverty level live in counties with no or low access to publicly funded clinics providing contraceptive care. That means that there are a lot of women who are in low income who don't have easy access to clinics to provide contraceptive care. And about half, 1.8 million, live in states without pharmacists prescribing laws. This tells us that pharmacists prescribed contraception can help close these geographic and policy gaps in accessing contraception. So, pharmacists prescribed contraception have gotten increasingly popular over the past decade. As of June of 2025, over 30 states, along with Washington, D.C, have passed legislation allowing pharmacists prescribed contraception. And policy that permits pharmacists prescribed contraception can look… can look a little different based on the state. There are a couple different pathways that states can use, and I'm gonna briefly touch on what those different pathways look like. So one of those pathways is a collaborative practice agreement, or a CPA. A CPA is a signed partnership with a prescriber that lets an individual pharmacist furnish contraception under specific agreed-upon protocols. Another pathway to pharmacist-prescribed contraception is a standing order, and this is a statewide clinician-signed directive that's usually signed by the state health authority's medical director. That allows pharmacists to dispense certain contraceptives to certain patients without a specific prescription for each patient. Another pathway is a statewide protocol, which empowers pharmacists to prescribe and dispense contraception under rules set by a board of pharmacy. It's sort of similar to a standing order, but it's not tied to a certain prescriber, like the standing order is. And then finally, there's the standard of care model, which is similar to independent prescriptive authority. And this expands a pharmacist's scope so that they can independently prescribe within defined clinical conditions using their professional judgment that aligns with the medical standards, rather than having to prescribe certain medications on a specific drug-by-drug basis. So those are some of the… levers the policy mechanisms used to create pharmacists prescribed contraception within different jurisdictions, but passing a policy that legalizes pharmacists prescribed contraception is just the first step. Implementing pharmacist-prescribed contraception can be really difficult. Due to policy, administrative, clinical, and logistical barriers. A diverse set of public health agencies, private entities, and healthcare professionals must work collaboratively to successfully implement a pharmacist-prescribed contraception program that meets the needs of pharmacists, patients, and the wider community. And this slide really walks us through some of the common barriers we hear around implementing pharmacist-prescribed contraception. So, those barriers include reimbursement, workforce readiness and training, and then public awareness. And I'll briefly touch on each of these barriers a little bit more. We routinely hear from pharmacists and other key stakeholders that identify payment for services as a key barrier to widespread implementation and uptake of pharmacists' prescribed contraception programs. Many pharmacists report resistance to participating in pharmacist-prescribed contraception without mechanisms in place that reimburse them for all of the relevant services they provide. So, specifically for the cost of counseling and the assessment services, as well as the cost of the medication and the standard dispensing fee. On top of that, pharmacists have also raised concerns about reimbursement rates for services, and a need to make sure that those are on par with other healthcare providers who also are prescribing contraception. Another group of barriers around pharmacist-prescribed contraception is related to workforce readiness and training. Once a… pharmacist-prescribed contraception policy is enacted, pharmacists and pharmacy leaders must be able to promptly and clearly inform the pharmacy workforce what the law permits, what required steps need to happen, and where to find guidance. And there's often a delay between when the policy is passed in legislation and when the answers to all of those questions happen. So, what are the required steps often has to come in the form of regulations from a state health agency. And sometimes that can take a while to be created. On top of that, standard and accessible training on pharmacist prescribed contraception usually needs to be developed for each state. And made available to pharmacists, and being able to be scaled out and maintained over time often presents challenges. Additionally, workflow considerations can impact implementation. Pharmacists prescribed contraception must integrate into existing workflows, including scheduling, privacy and space considerations. Standardized screening tools, documentation, and critically, billing workflows. Thinking through what codes pharmacists can use, what payer policies exist around pharmacist credentialing and enrolling as providers, and other revenue cycle processes. Finally, thinking through public awareness can also be a barrier to implementation. There's this balance between education and awareness campaigns. If done too early into pharmacist prescribed contraception's implementation, there's this risk that not enough pharmacists will be offering services, which could confuse and turn away potential patients from seeking out that service in the future. However, if education campaigns are doing too late, pharmacists may question the worth of offering a service if there isn't a patient demand to meet that service. Despite these barriers, many states are implementing pharmacist-prescribed contraception successfully. Research tells us the pharmacist-prescribed contraception is a safe and effective way to increase access while reducing cost. It also reaches