Obtaining Contraceptives from Pharmacists Boosts Continuous Adherence

Women who obtained direct contraceptive prescriptions from their pharmacist were able to minimize breaks in contraceptive coverage, while increasing their continuous adherence, according to researchers from Oregon Health & Science University.

The JAMA study took place between January 30 and November 1, 2019 and consisted of 410 women aged 18 to 50 years old from California, Colorado, Hawaii, and Oregon who visited their local pharmacy monthly to receive hormonal contraception prescribed by a clinician or pharmacist.

Published last week, the study showed that pharmacist prescriptions of hormonal contraception were associated with a contraceptive supply of more than 6 months dispensed, compared with traditional clinic-based prescriptions.

Twelve percent of women received a six-month or greater supply of contraceptives. A larger proportion of women received a prescription from a clinician (64.9 percent) than from a pharmacist (35.1 percent). Women receiving contraception from pharmacists were generally younger (59.6 percent).

Women obtaining a direct contraceptive prescription from a pharmacist received a greater supply of contraception than with clinic-based models. Greater supply has been associated with higher rates of continuous contraceptive adherence. 

Further, a greater proportion of women seeking contraception from a pharmacist (11.1 percent), than from a clinician (3.0 percent), reported being uninsured.

Pharmacists were also significantly more likely to prescribe a six-month or greater supply of contraceptives than clinicians were: 6.9 percent compared to 1.5 percent.

Overall, researchers found that 126 clinicians and 100 pharmacists were dispensing less than three months of coverage, which translates to 85 percent and 69.5 percent, respectively.

Pharmacies are generally located in the community they serve and do not require an appointment to be seen, researchers explained. They also typically have extended hours compared with clinics.

Experts believe these characteristics are important to decreasing breaks in contraceptive supply for current users and streamlining access for women wishing to initiate a contraceptive method.

Although the unintended pregnancy rate has fallen in the US in recent decades, 45 percent of all pregnancies are still unintended. Contraception is highly effective at preventing unintended pregnancy, but barriers exist to effective and consistent use.

“Our findings are promising that pharmacist prescriptions of contraception safely promote contraceptive continuation through minimizing breaks in contraceptive coverage by dispensing a supply of greater than 6 months,” researchers said. 

“As pharmacist prescription of contraception continues to increase nationally, evidence on this practice is needed to guide care,” they continued. “Our study supports a growing body of evidence demonstrating that pharmacist prescription of contraception is a promising strategy to improve contraceptive access.”

A separate California study mentioned in this JAMA study found that women who were prescribed a 12-month supply of contraceptives were almost twice as likely to be continuing to use the method at 15 months (40 percent) than women who received only a 1-month supply (21 percent). 

These findings were validated by a randomized trial, which showed that a seven-month versus three-month supply dispensed led to a significant increase in continuation rates at 6 months, researchers said.  

Additionally, women receiving a one-year supply of contraceptives have a 30 percent reduction in the odds of having an unplanned pregnancy when compared with women who are dispensed less than 3 months of coverage.

States are continuing to expand the scope of pharmacists to include direct prescription of hormonal contraception, as dispensing greater than one-month’s supply is associated with improved contraceptive continuation rates and fewer breaks in coverage.

In 2016, Oregon became the first state to implement legislation to allow pharmacists to independently prescribe hormonal contraception without a traditional clinic visit by following the CDC Prevention’s Medical Eligibility for Contraceptive Use.

Prevention is designed to help providers safely prescribe contraception. Since Oregon implemented its policy, 10 other states have passed legislation to allow pharmacist prescription of hormonal contraception without oversight from a supervising clinician.

^“This rapid, national expansion of a new cadre of contraceptive prescribers has key public health implications,” researchers said in the study. “It is important to understand who pharmacists are reaching and how their prescribing patterns are similar to, or distinct from, clinicians.”