Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

Pharmacist-prescribed contraceptives
September 2016


The November elections are nearing, and early voting begins as soon as September 23 in some states. As you consider how to cast your vote, avoid letting the federal general election politics suck all the oxygen from your electoral choices closer to home, at more local levels. Many reproductive health policies and regulations are decided at state levels. Unfortunately, many of those policies and regulations have served to roll back rights and diminish access to reproductive health resources. However, there has been some movement forward, toward increasing access to contraceptives, with provisions for allowing insurers to dispense 12-month supplies of contraceptives and pharmacists to prescribe hormonal contraceptives. (See the figure from Kaiser Family Foundation at the end of the text.)[1]

Allowing a 12-month contraceptive supply

The CDC’s Selected Practice Recommendations for Contraceptive Use (SPR) states that the more pill packs provided, up to 13 cycles, the higher the continuation rates.[2] Studies additionally indicate that a 12-month contraceptive supply dispensed at one time can reduce the risk of unintended pregnancy by as much as 30%.[3] Thus the SPR recommends that women be prescribed up to a 1-year supply upon initial and return visits, thereby allowing a women to obtain COCs in the amount she needs at the time she needs them.

Users have long struggled to make the fluidity of life and its demands fit neatly into a rigid calendar of contraceptive supply. However, as of today, eight states (Hawaii, Illinois, Maryland, Minnesota, New York, Oregon, Vermont, and Washington) and the District of Columbia have approved legislation for pharmacists to dispense and insurers to reimburse for multiple pill packs at one time: generally a year’s supply (6 months in Maryland). Eleven states (Alaska, California, Florida, Iowa, Michigan, New Jersey, Virginia, and Wisconsin) have introduced similar legislation. Where does your state stand? (See the map below).

Pharmacist-prescribed hormonal methods

Allowing pharmacists to prescribe hormonal contraceptives is another policy strategy to increase contraceptive access. Earlier this year, the American Congress of Obstetricians and gynecologists published a statement, which supported over-the-counter contraceptive pills in preference to pharmacist-prescription, that said, “Requiring a pharmacist to prescribe and dispense oral contraceptives only replaces one barrier — a physician’s prescription — with another.”[4] Though not a ringing endorsement, the statement followed a 2012 ACOG committee opinion indicating that “Pharmacists successfully used checklists to identify women without contraindications to OCs according to the World Health Organization’s Medical Eligibility Criteria for Contraceptive Use; blood pressure and body mass index also were measured… Continuation of use through 12 months was fairly high…”[5]

In hopes of making access to hormonal contraceptives easier and simpler for women, lawmakers in 12 states have introduced bills to allow pharmacist-prescribed hormonal contraceptives, according to the Guttmacher Institute.[6] California became the first state to pass such a bill, in late 2015, followed by Oregon in January 2016 and Tennessee in March. Experience from California suggests that many pharmacies are still trying to work out a strategy for providing the service. NPR reports that “Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.”[7] Pharmacists who choose to provide the service will need special training in providing hormonal contraception. And outside Oregon, the finances aren’t clear because most insurance providers do not pay for a pharmacist’s time to screen women, consult resources such as the U.S. Medical Eligibility Criteria, and counsel and educate clients about their contraceptive methods. That means that patients must pay for the service or the pharmacist must deliver the service for free. (In Oregon, the state Medicaid program reimburses pharmacists $35 for their time, NPR reports.)

What is entailed in pharmacist-prescribed contraceptive services? Below are illustrative excerpts from the California and Oregon bills:

California Protocol for Pharmacists Furnishing Self-Administered Hormonal Contraception[8]

Procedure: When a patient requests self-administered hormonal contraception, the pharmacist shall complete the following steps:

(A) Ask the patient to use and complete the self-screening tool;

(B) Review the self-screening answers and clarify responses if needed;

(C) Measure and record the patient’s seated blood pressure if combined hormonal contraceptives are requested or recommended.

(D) Before furnishing self-administered hormonal contraception, the pharmacist shall ensure that the patient is appropriately trained in administration of the requested or recommended contraceptive medication.

(E) When a self-administered hormonal contraceptive is furnished, the patient shall be provided with appropriate counseling and information on the product furnished, including:

(i) Dosage; (ii) Effectiveness; (iii) Potential side effects; (iv) Safety; (v) The importance of receiving recommended preventative health screenings; (vi) That self-administered hormonal contraception does not protect against sexually transmitted infections (STIs).

(5) Self-Screening Tool: The pharmacist shall provide the patient with a self-screening tool containing the list of questions specified in this protocol. The patient shall complete the self-screening tool, and the pharmacist shall use the answers to screen for all Category 3 and 4 conditions and characteristics for self-administered hormonal contraception from the current United States Medical Eligibility Criteria for Contraceptive Use (USMEC) developed by the federal Center for Disease Control and Prevention (CDC). The patient shall complete the self-screening tool annually, or whenever the patient indicates a major health change.

Oregon House Bill 2879[9]

The rules adopted under this subsection must require a pharmacist to:

(A) Complete a training program approved by the State Board of Pharmacy that is related to prescribing hormonal contraceptive patches and self-administered oral hormonal contraceptives;

(B) Provide a self-screening risk assessment tool that the patient must use prior to the pharmacist’s prescribing the hormonal contraceptive patch or self-administered oral hormonal contraceptive;

(C) Refer the patient to the patient’s primary care practitioner or women’s health care practitioner upon prescribing and dispensing the hormonal contraceptive patch or self-administered oral hormonal contraceptive;

(D) Provide the patient with a written record of the hormonal contraceptive patch or self-administered oral hormonal contraceptive prescribed and dispensed and advise the patient to consult with a primary care practitioner or women’s health care practitioner; and

(E) Dispense the hormonal contraceptive patch or self-administered oral hormonal contraceptive to the patient as soon as practicable after the pharmacist issues the prescription.

The rules adopted under this subsection must prohibit a pharmacist from:

(A) Requiring a patient to schedule an appointment with the pharmacist for the prescribing or dispensing of a hormonal contraceptive patch or self-administered oral hormonal contraceptive; and

(B) Prescribing and dispensing a hormonal contraceptive patch or self-administered oral hormonal contraceptive to a patient who does not have evidence of a clinical visit for women’s health within the three years immediately following the initial prescription and dispensation of a hormonal contraceptive patch or self-administered oral hormonal contraceptive by a pharmacist to the patient.

Planned Parenthood this election season

We can’t end this discussion without reminding readers that local elections influence the fate of Planned Parenthood, as some political leaders work toward eliminating the funding for their local and state clinics. For more information on the threat to Planned Parenthood, see our LateBreaker  “War on Planned Parenthood hurts women” at


—Deborah Kowal, MA, PA. Executive editor of Contraceptive Technology

[1] Kaiser Family Foundation. Oral Contraceptive Pills, Fact Sheet. July 6, 2016. Accessed at

[2] Centers for disease Control and Prevention. U.S. Selected Practice Recommendations for Contraceptive Use. MMWR 2013;62: 25.

[3] Foster, Diana Greene, PhD, Denis Hulett, Mary Bradsberry, Philip Darney, MD, MSc, and Michael Policar, MD, MPH. “Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies.” Obstetrics & Gynecology 117, no. 3 (March 2011): 566-72.

[4] American Congress of Obstetricians and Gynecologists. ACOG statement on pharmacist prescribing laws. January 4, 2016.

[5] Over-the-counter access to oral contraceptives. Committee Opinion No. 544. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012:120;1527-31.

[6] Guttmacher Institute. Trends in the states: first quarter 2016. Policy analysis 2016, April 13.

[7] O’Mara K. Law allows women to obtain birth control without prescription, but few pharmacies offer service. KQED NPR State of Health blog, May 16, 2016. At

[8] California Board of Pharmacy. Proposed Regulation to adopt §1746.1 protocol for pharmacists furnishing self-administered hormonal contraception. Accessed at

[9] 78th Oregon Legislative Assembly. Enrolled House Bill 2879, sponsored by committee on health care. Accessed at