By Rachel Crumpler
At least 1,309 pharmacists in 91 counties across North Carolina have trained over the past two years to prescribe hormonal contraception to consumers who walk into their pharmacies. They also are confirmed as providers with the state’s Board of Pharmacy.
While not all of these pharmacists have started to provide contraception services, they are working to do so — opening a new avenue for people to access contraception like hormonal patches or the pill.
Over 1,000 more pharmacists have registered for the necessary five-hour training to become birth control providers. So far, most of the interest has come from North Carolina’s more than 4,700 community pharmacists.
The state Board of Pharmacy is continuing its commitment to making it easier for more pharmacists to become providers. Pharmacists can still receive the training free of charge before the end of April as the state board has pledged to pick up the cost for up to 6,000 total pharmacists.
Mollie Scott, regional associate dean at the UNC Chapel Hill Eshelman School of Pharmacy, shared these numbers at a news conference at Central Pharmacy in Durham celebrating the new role of pharmacists in increasing access to contraception.
Under a law, House Bill 96, which went into effect Feb. 1, 2022, pharmacists in North Carolina gained the ability to provide hormonal contraceptives without a medical provider’s prescription to people 18 years and older, as well as to younger people as long as they have parental or legal guardian consent.
Since then, many stakeholders — pharmacists, state health department staff, physicians and more — have worked to accelerate pharmacists’ participation in providing hormonal contraception across the state. In August, many of these folks gathered in Chapel Hill for a contraception summit to identify barriers to implementation. Receiving insufficient reimbursement for providing the service was identified to be a main deterrent.
“We realized that community pharmacies were very eager to do this work, but they’re also small businesses, and they need to have sustainable financial models to be able to take time away from filling prescriptions and step into that counseling and education space to work with the patient to figure out what is the best contraceptive that meets their health care needs,” Scott said.
State health department staff and North Carolina Medicaid listened to this challenge. The Department of Health and Human Services — through the state’s Medicaid program — started enrolling pharmacists as Medicaid providers and paying for contraceptive counseling services provided in pharmacies this week.
This change is anticipated to fuel greater interest among pharmacists in providing the service, giving North Carolinians more places to access contraception — particularly at a time when getting contraception has become a more important consideration amid increased restrictions on abortion.
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Way to pay
Jennifer Burch, a pharmacist in Durham who offers hormonal contraception, said the Medicaid reimbursement will be crucial in making the practice sustainable for pharmacies.
“It does take time for pharmacists to sit down, and you can’t do that for free,” Burch said, explaining that previously only the cost of the product could be reimbursed.
Now that there’s a payment mechanism, she said it’s time for her to start promoting the service with customers and other pharmacists.
“Pharmacists are well-trained to provide some of these services,” Burch said. She noted that this can “free up some of the primary care doctors to see some patients who are sicker that need to see them faster, to see patients in rural areas who don’t even have primary care providers in their counties.”
Angela Smith, director of pharmacy and ancillary services at NC Medicaid, also acknowledged the importance of the new reimbursement, adding that it’s the first time the program has been able to reimburse pharmacists for clinical services outside of dispensing medications and administering immunizations or injections.
As a result of this change, Smith said Medicaid members can walk into a pharmacy offering pharmacist-prescribed contraception and leave the same day with up to a 12-month supply of birth control in hand — with zero out-of-pocket costs.
“This is so important,” she said. “Across North Carolina, there’s a lot of rural areas, and the pharmacist many times is more accessible than the physician prescriber. So we really do believe this is going to increase access for Medicaid members.”
Burch said she would like to see other insurers follow NC Medicaid’s lead, offering similar reimbursement.
Until then, many pharmacies offering pharmacist-prescribed contraception need to charge a fee to customers.
Anna Baird, a pharmacist at Realo Drugs in New Bern, previously told NC Health News that to provide the service at her chain of stores, pharmacists charge a $40 consultation fee, which is in line with copays for doctor appointments. That fee can deter some people from using the service, she said.
Combating contraceptive deserts
Pharmacists expect that other sites will still be the main prescribers of birth control, but they are working to equip themselves as an additional access point for this aspect of reproductive care.
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.
Since almost 90 percent of the U.S. population lives within five miles of a community pharmacy, access to contraception at these sites could improve access to contraception.
Twenty-eight states and the District of Columbia allow pharmacists to provide contraceptive care, according to the Guttmacher Institute, though the language of the laws governing the practice varies from state to state. Research shows people may opt to get contraception at pharmacies because they are nearby, have extended hours and don’t require appointments.
Pharmacies have the potential to fill critical gaps, said Betsey Tilson, state health director.
“Having the full range of reproductive health services is critically important — and that’s inclusive of contraception,” Tilson said. “More than 50 percent of our pregnancies are unintended. And so by decreasing that, we can improve our maternal and health outcomes and can also improve economic stability of our families, professional and educational, as well.”
She said it’s important to “empower people to make choices for themselves of when is the right time for them to have a pregnancy or not.”
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