For most women, birth control isn’t exactly an easy item to pick up.
First, you have to make a doctor’s appointment and wait for an opening. Then you have to get yourself to the clinic, taking time off work to wait some more to get a health exam you might not even be due for — which you may not have the insurance to pay for. Then you take the prescription to the pharmacy, where there’s more waiting. The whole process can easily take weeks.
In some states, it can take less than 10 minutes.
There are 12 states, plus Washington, D.C., where it’s currently legal for pharmacists to prescribe birth control. That means you can walk into your local pharmacy, have a quick conversation, get your blood pressure taken, and walk out with a new batch of pills. (Some states allow pharmacies to prescribe the patch and Depo-Provera shot, too.)
But many pharmacies that could legally offer the service still don’t. So when Kroger, a national grocery store, announced last week it would be prescribing birth control at every one of its pharmacies across seven states, the chain dramatically increased the number of women who will be able to get birth control without first going to the doctor.
Some states have worked out a better system than others, says Sally Rafie, a pharmacist based in San Diego and the founder of Birth Control Pharmacist, an organization that supports pharmacists providing contraception. California, one of the first states to green-light pharmacy-prescribed birth control, has approximately 500 pharmacies that offer the service, she says. In New Mexico, the number hovers around 20.
That’s mostly because different states have different regulations, said Jim Kirby, senior director of Kroger Health Services. New Mexico, for example, requires extensive training for pharmacists who want to get certified to prescribe birth control.
Pharmacy-prescribed birth control has been so slow to catch on mostly because insurance companies don’t typically cover the service, said Kate Grindlay Kelly, a project director at Free the Pill, who researches over-the-counter birth control. While insurance will cover the cost of the actual medication, many companies aren’t yet reimbursing pharmacists for the time it takes to prescribe, as they would a doctor — so the patient usually gets that bill instead. Kroger pharmacies charge patients $35 for the pharmacist’s time.
“If their time is not factored in, pharmacists are not incentivized to offer this service,” said Grindlay Kelly. If it’s considerably cheaper for women to keep getting their birth control from their doctors, they’re less likely to make the switch. “So as states are passing the laws, it’s very important that the pharmacist’s time is taken into account.”
General awareness is another issue. Many people just don’t know they can start going to their pharmacies for birth control. And low numbers, in turn, make pharmacies hesitant to offer the service, said Rafie. To spread the word, Kroger is advertising birth control prescriptions in its stores and on its website. Computer systems at Kroger locations will also prompt pharmacists to mention the new service to clients who will soon need to re-up their prescriptions.
But the problem goes deeper than all that, said Kirby. Pharmacies are fighting a “patient perception barrier.” People are used to having a very particular kind of interaction at the pharmacy, he said. They hand over the prescription, the pharmacist hands over the medication, they pay, they leave.
“Typically the pharmacy-patient experience has truly been transactional,” he said. “People need to know about this care, yes — but they also need to believe that it’s the same kind of care they would receive elsewhere, at their doctor.”
The service is “certainly not a revenue generating thing,” said Rafie. There aren’t enough patients for that. On a busy day at the pharmacy where she works in San Diego, she might prescribe birth control to two patients, she said. Companies like Kroger have other reasons for opting in.
“I think maybe they want to be at the forefront of this,” said Rafie. “Over time as people start to pick up on this service, I think we’re going to see a lot more people coming in.”
The idea does have broad bipartisan support. States that have legalized the service fall at both ends of the political spectrum. Pharmacists can now prescribe birth control in left-leaning California and Oregon, but also in right-leaning Idaho and Utah. That’s because birth control is extremely popular, said Rafie — and allowing pharmacists to prescribe it would make it considerably easier to access, especially for low-income women.
“For some people going to the doctor means taking a day off work or finding a babysitter,” said Rafie. “It can be quite the trip versus popping into your local pharmacy in the evening or on the weekend. It opens up options for folks.”
Some worry about taking doctors out of the birth control prescription process. Hormonal birth control can come with substantial side effects, Missouri-based OB/GYN Poppy Daniels told The Daily Beast. To prescribe birth control without physician oversight, she said, is “ridiculous.”
“Pharmacists don’t have the time to do the level of counseling that I think is needed and warranted,” said Daniels. “They’re busy. The people picking up [the prescription] are busy. It’s just not realistic.”
But Rafie says pharmacist consultations are comparable to the kind of counseling a patient might receive at the doctor. While her birth control consultations sometimes only take 10 minutes, she’ll often spend much longer talking to a patient, evaluating her history and future options.
Kirby is hopeful that pharmacies will soon become the go-to place for birth control. Just think about the flu shot, he said. Twenty years ago, no one was going to the CVS or the grocery store to get a vaccination. But somehow, now, that’s the new normal.
“When people think about flu shots, they think ‘pharmacy,’” said Kirby. “Years from now, when people think about birth control, I bet they think ‘pharmacy,’ too.”