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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATEIn fall 2006, NARAL Pro-Choice Wisconsin is working towards passing an ordinance in the Madison Common Council to increase access to EC. The ordinance, which has 15 of 20 council members as co-sponsors, would require that pharmacies which do not carry or are out of stock of emergency contraception post a notice at the pharmacy window. The notice would state that EC is not available there, and list the name and location of the nearest pharmacy that does have EC. It also requires the City of Madison to produce a brochure about EC and its availability to distribute to sexual assault survivors at all hospital emergency rooms. The ordinance was prompted by a 2005 NARAL Pro-Choice Wisconsin Foundation study revealing that 1 in 4 pharmacies in Madison did not carry emergency contraception. Because NARAL's survey showed that 42% of pharmacies in Wisconsin's largest cities do not stock EC, the group is already working in communities around the state to pass similar local legislation. On 12/8/05, Wisconsin Gov. Jim Doyle (D) authorized Attorney General Peg Lautenschlager’s request for permission to sue FDA based on the agency’s handling of Barr Pharmaceuticals’ application to grant over-the-counter status to Plan B. As a result, the State of Wisconsin is seeking to intervene in the Tummino lawsuit in the Eastern District of New York. Read the Complaint of the Intervening Plaintiff (PDF-188K) and the related Attachments (PDF-2.8MB). There is currently no known activity promoting direct pharmacy access to EC. New legislation, AB 795, was introduced on 10/31/05 to increase EC access in multiple ways including: school district human growth and development programs, requiring a hospital to provide information and EC to a sexual assault victim, and requiring a pharmacist to dispense contraception. In March 2005, the University of Wisconsin Health Services ran a series of ads for spring break, one which encouraged condom use and having EC in advance. The ads sparked outrage from conservative groups, and State Rep. Dan LeMahieu planned to draft legislation to ban any state university health center from advertising or distributing EC. The Attorney General noted that this proposal was likely unconstitutional. An informational event on access to EC in the state was held in January 2005 by the Wisconsin Family Planning and Reproductive Health Association (WFPRHA), the Wisconsin Coalition Against Sexual Assault, Health Care Training & Education, and the Wisconsin Coalition Against Sexual Assault. Speakers included the Lt. Governor, the Attorney General and State Senators and Representatives, and a press conference followed the event. In August 2004, WFPRHA launched an EC campaign, using billboards, television and radio ads to increase public awareness about EC and its hotline. In addition, the organization will partner with local agencies such as rape crisis centers and women’s shelters, to improve access to EC. WFPRHA has been identified as a one possible source to support and lead an EC pharmacy access initiative. The Association has developed a toll-free hotline (1-866-ECFIRST) to help women access EC. Callers are connected to a nurse who either directs them to the nearest family planning clinic or prescribes EC after conducting an assessment. EC can be mailed to a woman's home overnight if she lives far away from a pharmacy or clinic. WFPRHA has worked with various college campuses in the state to educate students about EC and include informational materials in orientation packets. NARAL Pro-Choice Wisconsin offers education on EC, particularly advance prescription, to healthcare providers across the state, emphasizing its role in primary care for women. Led by volunteer healthcare providers, the training consists of a PowerPoint presentation, pre-printed prescription pads, and informative handouts. NARAL Pro-Choice Wisconsin is also undertaking a project to gauge pharmacy access to EC and the accuracy of information on EC provided by pharmacies. In 2003, a measure (AB 63) that would allow pharmacists to refuse to dispense emergency contraception was passed in Labor Committee with vote of 6-2 and has been referred to the Committee on Rules. For press coverage in this state, click here. Please Note: This state has an optimal environment for EC protocols between pharmacists and physicians. To learn more click here.
CONTACTSLon Newman Kelda Helen Roys, J.D. Chris Decker, R.Ph. Michael Vaughn Sara Finger
USEFUL LINKSWisconsin Department of Regulation & Licensing - Pharmacist Pharmacy Society of Wisconsin Wisconsin State Legislature Planned Parenthood of Wisconsin NARAL Pro-choice Wisconsin
PROTOCOL ENVIRONMENTOptimal Environment: No Revision to Authority Necessary Existing statutes and regulations would accommodate pharmacists’ initiation of emergency contraception, generally under a collaborative practice agreement (protocol) with a prescriber. 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. WISCONSIN Pharmacists practicing in any setting may operate under collaborative drug therapy management authority granted though delegation of a medical act by a physician and pursuant to protocol that is valid for two years. The protocol must be approved by the physician. The scope of practice is outlined in protocol and may include initiating, modifying and monitoring drug therapy; ordering and performing lab tests, assessing response to therapy, education and counseling; and administering of medicine. There is no limitation on opportunities for collaborative practice. Statutory authority is defined within the subchapter on “Medical Examiners Board” which details an exemption from being categorized as “practicing medicine” for any person other than a physician assistant who is providing patient services as directed, supervised and inspected by the physician. The Wisconsin Medical Examining Board issued a clarifying letter on 8/29/2000 describing its interpretation of this Section and authorization for physicians to delegate CDTM to pharmacists. The Pharmacy Examining Board statutes define the practice of pharmacy partly as making therapeutic drug selections according to written protocol or procedures previously established. Vaccination protocol is also described in the definitions. Pharmacists practicing in any setting may administer medications. There are no limits on the route of administration or eligible products; however, pharmacists may administer injectable drugs (other than immunizations) only to teach the patient self-administration technique, and only after completing required training. Regulations through the Medical Examining Board define requirements for prescription orders. Immunization authority lies within Pharmacy Board regulations giving authorization to pharmacists that have met certain criteria and having liability insurance. Statutory authority: Wis. Stat. § 448.03(2)(e) – Medical Examining Board, § 450.01(16), § 450.035 – Pharmacy Examining Board Regulatory authority: Wis. Admin. Code Phar 7.10, Med.17.06
WISCONSIN STATUTE Medical Examining Board 448.03 License or certificate required to practice; use of titles; civil immunity; practice of Christian Science. (1) LICENSE REQUIRED TO PRACTICE.
NOTE: Par. (c) is created eff. 1–1–03 by 2001 Wis. Act 89.,(1m) CERTIFICATE REQUIRED TO PRACTICE. No person may practice respiratory care, or attempt to do so or make a representation as authorized to do so, without a certificate as a respiratory care practitioner granted by the board. (2) EXCEPTIONS. Nothing in this subchapter shall be construed, either to prohibit, or to require, a license or certificate under this subchapter for any of the following: …
CHAPTER 450 PHARMACY EXAMINING BOARD 450.01 Definitions. In this chapter: (1) “Administer” means the direct application of a vaccine or a prescribed drug or device, whether by injection, ingestion or any other means, to the body of a patient or research subject by any of the following:
… (16) “Practice of pharmacy” means any of the following:
(17) “Practitioner” means a person licensed in this state to prescribe and administer drugs or licensed in another state and recognized by this state as a person authorized to prescribe and administer drugs. … (21) “Prescription order” means an order transmitted orally, electronically or in writing by a practitioner for a drug or device for a particular patient. (22) “Vaccination protocol” means a written protocol agreed to by a physician, as defined in s. 448.01 (5), and a pharmacist that establishes procedures and record-keeping and reporting requirements for the administration of a vaccine by a pharmacist for a period specified in the protocol that may not exceed 2 years. 450.035 Administration of drug products and devices; vaccines. (1g) In this section, “drug product or device” does not include a vaccine. … (1r) A pharmacist may not administer by injection a prescribed drug product or device unless he or she has successfully completed a course of study and training in injection technique conducted by a course provider approved by the American Council on Pharmaceutical Education or the board. A pharmacist may administer a prescribed drug product or device under this subsection only in the course of teaching self-administration techniques.
WISCONSIN REGULATIONS PHARMACY EXAMINING BOARD Phar 1.02 Definitions. As used in chs. Phar 1 to 16: (4) “Institutional pharmacy” means practice in a licensed pharmacy providing pharmaceutical services primarily on an inpatient basis. (12) “Practice of pharmacy” has the meaning under s. 450.01 (16), Stats. Phar 7.10 Administration of drug products and devices other than vaccines. A pharmacist may administer drug product, as defined in s. 450.01 (11), Stats., or device, as defined in s. 450.01 (6), Stats., in the course of teaching a patient self-administration techniques except a pharmacist may not administer by injection a prescribed drug product or device unless he or she satisfies each of the following:
History: Cr. Register, December, 1999, No. 528, eff. 1–1–00.
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