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Straight, No Chaser In The News: Birth Control Pills Without a Prescription and Expansion of Pharmacists’ Prescribing Authority

By Jeffrey Sterling, MD July 22, 2019



In the news are updates from California and Oregon on new state laws allowing females to obtain oral contraceptive pills directly from a pharmacist without requiring a prescription from a physician. Let’s review the how and why of this.

  1. Why was there a need for this, you may ask?

Women’s health advocates have successfully made the case in these states that women should have similar opportunities as men to obtain birth control.

  1. Isn’t comparing condoms with hormonal pills like comparing apples and oranges? One’s much safer than the other, right?

It’s not a competition. Safe is safe. Oral contraceptives have been so widely studied for so long that the American College of Obstetricians and Gynecologists have recommended availability over the counter.

  1. What’s with California not having an age restriction?

There’s nothing especially odd about that once you understand laws known as “muture minor doctrines” regarding one’s body are already in place in various ways nationally. In fact, minors of any age may consent to family planning services when those services are funded in full or in part by Federal Title X monies. Under California state law (Cal. Family Code § 6925), a minor of any age may consent to medical care related to the prevention or treatment of pregnancy, including contraception.

  1. It can’t be that simple? What protections are in place?

Regulations differ between the two states, but here are examples of initial efforts to protect.

  • Pharmacists can only dispense oral contraceptives after providing a health screening, including a blood pressure check.
  • Women under 18 must show proof of prior birth control prescriptions from a physician.
  • Pharmacists are being required to undergo additional training.
  1. So pharmacists are taking on some of the responsibilities of physicians?


Yes and by design. Part of the fall out from the Affordable Care Act appears to be the ongoing peeling away of responsibilities once exclusively held by physicians (depending on your point of view; this is often politically cited as “relieving the burden of physicians”). The biggest of these responsibilities appears to be prescriptive authority. There is an increasing number of circumstances in which pharmacists are now functioning beyond their prior role without physician consent needed, including the following:

  • administration of immunizations,
  • administration of medicines for smoking cessation
  • administration of narcotic overdose antidotes.
  • administration of the “morning-after pill”
  • administration of travel medicines


In as much as the conversation is about women’s health and greater access to treatment, reform is a good thing. In the examples in which new health considerations are rushed through as part of a political agenda instead of as a measure of public health, the risk exists that equal measures of good and harm may be created. A serious and robust conversation needs to occur about how primary care physicians are to keep up with an increasing number of outlets for patients to receive medications. Such things matter, not only for routine health maintenance but particularly in managing side efforts and emergencies related to medication use. Not having access to complete and accurate medication lists can be the difference between life and death in an emergency. All in the public domain would do well to be aware and be involved in these conversations as new prescriptive authority measures migrate across the country. You have a stake in what the future of healthcare becomes.
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0 thoughts on “Straight, No Chaser In The News: Birth Control Pills Without a Prescription and Expansion of Pharmacists’ Prescribing Authority

  1. This was a very interesting article. You do a great job of detailing the ongoing conversation around birth control and whether its connection to the provider-patient relationship is absolutely necessary. I am wondering if you have any insight as to what the possible implications would be on the cost of birth control if it is offered exclusively over the counter? Or is the thought behind this movement to offer both over the counter and prescription birth control options to women?
    If it is the former, Would that mean that women, who receive birth control for free or at a discount, will now pay the higher premium monthly by having to purchase birth control without a prescription? In a moment where women have saved 1.4 billion on birth control expenses since the unveiling of the ACA, we could postulate that birth control consumption and access has also seen an increase due to its cost reduction. Would providing it over the counter possibly swing the pendulum in the opposite direction?
    I’m interested in learning more about the topic and would love to get any more insight you have on it!

    1. Great questions, and thank you Melissa! The implications are fairly straightforward. This is a tradeoff between better access and more control by women over their own bodies versus a drop in quality control. There is a relative and absolute standard in play here. On an absolute scale, the premise is pharmacists are “good enough” to counsel patients in making these health care choices. I don’t hear anyone suggesting that’s not the case. Of course on the other hand, they’re not physicians, and you’re losing whatever benefit (perceived and real) you’d have by having physicians direct your care. Regarding reimbursement today’s announcement from the White House (Pres. Obama) should put you at ease. It is quite clear that the current administration will do whatever is necessary to ensure coverage under the Affordable Care Act for women’s health issues. Thanks for the question and for following Straight, No Chaser!

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