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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATEThere is currently no known activity promoting direct pharmacy access to EC. This has been flagged as a politically sensitive issue in the state. Planned Parenthood of the St. Louis Region, NARAL Pro-Choice Missouri, and Missouri Religious Coalition for Reproductive Choice worked together in 2002 to explore collaborative agreements with pharmacists, but it was put on the back burner because of concerns that this could potentially harm pharmacist relationships with physicians. Planned Parenthood also tried to get a joint resolution for an EC educational project, but was unsuccessful. Currently, NARAL Pro-Choice Missouri is working to get EC endorsements from diverse stakeholders in women’s health and is organizing teams across the state on various EC related goals. The Access Project, a grant-funded, 3-phase initiative by NARAL Pro-Choice Missouri Foundation to increase access to reproductive health care services in Missouri, surveyed hospitals and pharmacies about their policies regarding access. Results were published in The Access Project: An Assessment of Reproductive Health Care Services in Missouri, a 35-page booklet including statistical information on issues such as hospital access to contraception and pharmacy access to EC. Findings include: 33% of pharmacists dispense EC to women with a prescription signed by a physician. Of the pharmacies that do not fill prescriptions for EC, only 35% provide referrals for EC. Survey results are being used to educate and mobilize supporters to take action to increase public awareness and eventually, access. To raise awareness about the availability of EC, a survey of 250 pharmacies in the state was conducted by Planned Parenthood in March 2004. The study showed that only 31% of pharmacies stocked EC, largely because of low demand. Click to view the results (DOC-28K), intake form (DOC-32K), and recruitment flyer (DOC-28K) used to enlist consumers to survey the pharmacies. A bill, SB 1119, was introduced in the Missouri legislature in 2004, and in at least five other states, to allow pharmacists to refuse to dispense EC due to moral reasons. This bill did not pass the legislature. In 2004, three bills promoting access to EC were filed in the Missouri General Assembly. SB 1158 and HB 1657, companion bills known as the “Women’s Right to Know Act”, would have called on the Missouri Health Department to educate women and providers about FDA-approved contraceptives, including emergency contraception. The Women’s Right to Know bill would have also required the Health Department to inform women that under Missouri’s contraceptive equity law, all health insurance plans that cover prescription drugs must include coverage for contraceptives. In addition, SB 1346, the “Emergency Care for Sexual Assault Victims Act of 2004,” would have required hospital emergency rooms to inform victims of sexual assault about emergency contraception and to make it available to them if they request it. All three bills did not pass. In 2003, a bill (HB 691(PDF-28K)) calling on the State Health Department to inform medical providers about EC was introduced. There was a hearing in the House but it did not reach the Senate and was never voted on. SB 393 was a mirror EC education bill that did not get a committee hearing. A group in St. Louis’ North County is enthusiastically continuing to work on their hospital’s EC in the ER access.
CONTACTSRon Fitzwater, C.A.E. Sue Hilton Alison Gee Debra Knox Deiermann
USEFUL LINKSMissouri Board of Pharmacy Missouri Pharmacy Association Missouri General Assembly Planned Parenthood of Kansas & Mid -Missouri Missouri Family Health Council, Inc. Tri Rivers Planned Parenthood Planned Parenthood of the St. Louis Region Planned Parenthood of the Rocky Mountains
PROTOCOL ENVIRONMENTPossible Environment: Revision to Existing Authority Required This state permits collaborative practice agreements or a similar agreement between physicians and pharmacists. However, some modification of existing statutes and/or regulations is required to allow pharmacists to initiate EC for the general community. Pharmacist initiation of EC would require:
PHARMACY PRACTICE ACTPharmacy Practice Act Regulatory and Statutory Authority Note: The text presented below has been prepared by the American Pharmacists Association for the Pharmacy Access Partnership and reflects legislation or regulation promulgated as of June 15, 2003. MISSOURI Current law authorizes pharmacist administration of any medication, via any route of delivery, to an individual patient on the order of a physician (or other prescriber operating under a collaborative prescribing agreement with a physician). This would include immunizations and other medications, such as emergency contraceptive. Pharmacists working under collaborative practice agreements with physicians for the administration of immunizations must have successfully completed an ACPE-approved training program. Nurses have explicit authority to practice under collaborative agreements with physicians. Expanding this authority to include pharmacists would likely require only the insertion of “licensed pharmacist” after each mention of “nurse” in this statute. Statutory authority: Rev. Stat. Mo. § 338.010; 338.095 Regulatory authority: N/A
MISSOURI STATUTE Chapter 338 338.010. 1. The “practice of pharmacy” shall mean the interpretation and evaluation of prescription orders; the compounding, dispensing and labeling of drugs and devices pursuant to prescription orders; the participation in drug selection according to state law and participation in drug utilization reviews; the proper and safe storage of drugs and devices and the maintenance of proper records thereof; consultation with patients and other health care practitioners about the safe and effective use of drugs and devices; and the offering or performing of those acts, services, operations, or transactions necessary in the conduct, operation, management and control of a pharmacy. . . . * * * (RSMo 1939 § 10005, A.L. 1951 p. 737, A.L. 1989 S.B. 39, A.L. 1990 H.B. 1287) Pharmacists and Pharmacies 338.095. 1. The terms “prescription” and “prescription drug order” are hereby defined as a lawful order for medications or devices issued and signed by an authorized prescriber within the scope of his professional practice which is to be dispensed or administered by a pharmacist or dispensed or administered pursuant to section 334.104, RSMo, to and for the ultimate user. The terms “prescription” and “drug order” do not include an order for medication which is provided for the immediate administration to the ultimate user or recipient. * * * 3. A licensed pharmacist may lawfully provide prescription or medical information to a licensed health care provider or his agent who is legally qualified to administer medications and treatments and who is involved in the treatment of the patient. The information may be derived by direct contact with the prescriber or through a written protocol approved by the prescriber. Such information shall authorize the provider to administer appropriate medications and treatments. 4. Nothing in this section shall be construed to limit the authority of other licensed health care providers to prescribe, administer, or dispense medications and treatments within the scope of their professional practice.
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