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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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New MexicoPharmacist clinicians in New Mexico arguably have broader authority than pharmacists in any other state. However, they are also governed by complex rules of eligibility. In 1992, New Mexico passed a law that created a health care group, “pharmacist clinicians”, which permits eligible pharmacists to prescribe drugs and have their own DEA number under protocol with a physician. The state passed a second law in 2001 (SB353) that allowed the New Mexico State Board of Pharmacy to adopt protocols for a limited class of drugs, including vaccines and immunizations, and gave pharmacists prescribing authority under these protocols. The 2001 law specified that the Board of Nursing and the Board of Medical Examiners must first approve all protocols adopted by the Board of Pharmacy. SB353 also added pharmacists to the list of “practitioners” in New Mexico. This list includes persons licensed or certified to provide drugs. The New Mexico Pharmaceutical Association (NMPA) sponsored both the 1992 and 2001 bills. Legislation for the pivotal bill, SB353, was quietly initiated and led by Dale Tinker, Executive Director of the NMPA. RegulationsNew Mexico’s landmark legislation paved the way for the next step – adopting new state regulations for emergency contraception. Effective December 2002, the New Mexico State Boards of Pharmacy, Nursing and Medical Examiners approved regulations (DOC-44K) that addressed both EC and immunizations, allowing pharmacists to provide these drugs under a Board approved protocol. The final step in the process was developing the EC protocol and securing approval from the three State Boards and their distinct constituency groups. This process took approximately six months, and New Mexico finalized its EC protocol (DOC-48K) in May 2003. EC Work GroupIndependent of the 2001 legislative effort led by NMPA, the New Mexico State Department of Health convened an ad hoc work group of clinicians to address EC issues. Physicians with the University of New Mexico Departments of OB/GYN and Family Practice were actively involved in this group. After the Pharmacy Practice Act was amended in 2001, the group expanded and both directors of the New Mexico Pharmacists Association and Planned Parenthood became involved. The EC Working Group now operates as a multidisciplinary coalition with approximately 15-20 members. Most members are physicians and nurse practitioners from the community, school-based clinics, private practice, the university and other sectors. Drs. Espey and Trigg, the physician leaders associated with the State Health Department and University of New Mexico School of Medicine Department of OB/GYN, played key roles in working with the Boards of Nursing and Medical Examiners. Through the coordinated action of the EC Work Group, they reviewed protocols from other states and worked with the NMPA to develop one for New Mexico. Equally important, they facilitated Board approval of the protocols by attending Board meetings to answer medical questions about EC. One issue the group considered during development was how complex the protocol should be. They ultimately decided to make the protocol as simple as possible on the grounds that EC is safe, and if it becomes available over-the-counter, women will not need interaction with a health care provider or pharmacist. SupportersPharmacists were supportive of the change in the Pharmacy Practice Act because it expanded their scope of practice. From the viewpoint of the NM Pharmaceutical Association, pharmacists are highly trained professionals who are capable of more responsibility than they are currently given. Amending the Pharmacy Practice Act was seen as an opportunity to expand pharmacists’ roles. Physicians, particularly from the State Department of Health, have been strongly supportive of pharmacy access to EC, in part, because New Mexico has a very high unintended pregnancy rate — 46% of all mothers with live births and 66% of teens (15-19) experienced unintended pregnancies according to New Mexico Pregnancy Risk Assessment Monitoring System data. The medical society has also been generally supportive. When the regulations were under review, physicians wanted assurance that they would receive notification when their patients were immunized and, with patient approval, were given EC. These conditions were written into the protocols.
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