Sample policy proposal

Grace Bridges Policy proposal - page 1 Grace Bridges NYC Urban Fellows - 2018 Policy proposal 1/10/2018

Policy proposal: Authorization of pharmacists to distribute contraceptive medications A federal mandate of the Affordable Care Act which took effect in 2011 requires birth control be covered on health care plans as a preventative service with no co-pay from the patient. While this was a step forward in reducing the financial burden of obtaining birth control for women on qualifying plans, receiving birth control still entails regular visits with a doctor who may require a pelvic exam be performed before writing a prescription. This process is burdensome to all women and becomes costprohibitive to low-income or uninsured women, making access to prescription contraceptives in the United States highly inequitable.

According to the Census Bureau, in 2015 the largest demographic of the population of New York living in poverty was women age 25-34, with 8.8% of women in this age range living below the poverty line; 7.3% of women age 18-24 and 6.9% of women age 35-44 live in poverty. Additionally, 10.8% of women age 25-34 had no health care coverage, followed by 8.6% of women age 35-44 and 5.4% of women age 18-24. These indicators of poverty and health care coverage among women of childbearing age and most in need of contraceptive access illustrate an equity issue in the state of New York among these demographics. Living in poverty or without health care coverage greatly impedes, if not prohibits, access to the costly appointments with medical professionals and prescriptions necessary to receive contraceptives and avoid unintended pregnancy.

According to a study conducted by the Guttmacher Institute analyzing data from the 2010 census, 55% of pregnancies in New York were unintended that year. Of these unintended pregnancies, 34% resulted in births and 54% ended in abortions. Limited access to contraceptives resulting in unintended pregnancy can have extremely detrimental effects on women and their children; studies show links between unintended pregnancy and anxiety and depression, increased conflict in relationships, as well as significantly reduced levels of educational and economic attainment. In addition to the physical and emotional toll unintended pregnancies can have on a woman, these pregnancies also have an economic impact on the communities in which they occur. Unintended pregnancies in New York alone cost the state and federal governments $1.5 billion in 2010; of this, $601.1 million was paid by the state (Guttmacher Institute).

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A policy approach legislators in New York could take to reduce this inequity could be to authorize pharmacists to distribute birth control. California and Oregon have already seen success in passing similar laws regarding new authorizations for pharmacists. Both states now allow women to receive oral contraception directly from a pharmacist, eliminating the need for an appointment at a healthcare provider’s office in addition to a visit to the pharmacy. Oregon also made accessing contraception easier by allowing pharmacists to distribute up to a year supply of oral contraceptives, reducing the number of trips to the pharmacy for refills significantly. Contraceptives distributed by a pharmacist are still protected by the Affordable Care Act mandate requiring coverage of prescription contraceptives with no co-pay because these are changes to distribution regulations rather than changes to the over the counter status of contraceptives (Hersher). According to a 2006 study published in the scientific journal Contraception, 41% of women not using contraception would begin using it if it were available directly from a pharmacist, with interest in direct access at the pharmacy highest among uninsured and low-income women (Landau).

An obstacle to implementing these regulatory changes could be that pharmacists are not able to perform the pelvic exams so often required by doctors before writing a prescription. These exams are an important element of routine women’s health care, and can help identify sexually transmitted infections, ovarian cysts, cancer, and other disorders. Although appointments for contraceptive prescriptions have become associated with pelvic exams, the World Health Organization and the American College of Obstetricians and Gynecologists have concluded that contraceptives can safely be prescribed without a pelvic exam (Norton). Providing birth control to adolescents is also a controversial issue to be addressed when considering these regulatory changes. For example, Oregon’s laws require people under 18 to visit a doctor for their first contraceptive prescription before receiving contraceptives directly from pharmacists. However, a review of oral contraceptive research in the Journal of Adolescent Health finds that “there is no scientific rationale for limiting access to […] oral contraceptive product[s] by age” (Upadhya).

The Science and Law Committee and the Sex and Law Committee of the New York City Bar Association submitted a letter to federal leaders and lawmakers associated with the FDA to encourage the status change of oral contraceptives from prescription to over the counter in February 2016. While advocating for this change at the federal level is an important step in making oral contraceptives more easily and equitably accessible to all women, I would suggest that these committees now shift their focus to garnering support from state legislators to allow pharmacists to distribute contraceptives. This

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regulatory change has proven to be successful in other states and would have an immediate positive impact on the lives of New Yorkers.

Hersher, Rebecca. “Over-The-Counter Birth Control Pills Would Be Safe For Teens, Researchers Say.” NPR, NPR, 16 Mar. 2017, www.npr.org/sections/health-shots/2017/03/16/520268440/over-the-counter-birth-control-pillswould-be-safe-for-teens-researchers-say.

Landau, S. C., Tapias, M. P., & McGhee, B. T. (2006). Birth control within reach: A national survey on women’s attitudes toward and interest in pharmacy access to hormonal contraception. Contraception, 74, 463-470.

Norton, Amy. “Women Seeking Birth Control Get Unneeded Pelvic Exams.” Reuters, Thomson Reuters, 22 Nov. 2010, www.reuters.com/article/us-birth-control/women-seeking-birth-control-get-unneeded-pelvic-examsidUSTRE6AL67X20101122.

“State Facts About Unintended Pregnancy: New York.” Guttmacher Institute, www.guttmacher.org/factsheet/state-facts-about-unintended-pregnancy-new-york#7.

Upadhya, Krishna K. et al. (2017) Over-the-Counter Access to Oral Contraceptives for Adolescents. Journal of Adolescent Health, 60, 634-640.