Access to contraceptive care has been shown to have many health and economic benefits. However, many individuals experience barriers to accessing contraceptive care. In the context of a shifting contraceptive care landscape, including legal considerations and challenges, workforce shortages, health care deserts, innovations in care delivery, and financing constraints, many states have proposed or enacted policy changes to improve contraceptive care access.
Many states are expanding existing laws or enacting new laws that authorize pharmacists to prescribe a range of hormonal contraceptive methods. Pharmacist prescribing policies have historically been used across the U.S. to improve access to preventive services, vaccinations, and certain medications (e.g., naloxone, pre-exposure prophylaxis, influenza vaccine). State pharmacist prescribing policies grant individual pharmacists the authority to prescribe certain medications with limited or no physician oversight or authorization. By expanding pharmacists’ scope of practice to include prescribing contraceptives, states may improve access to hormonal contraceptives by eliminating common barriers associated with obtaining contraceptives.
North Carolina has over 3,000 retail pharmacies and over 18,000 pharmacists that provide various levels of care. By engaging the current pharmaceutical workforce, North Carolina is leveraging pharmacist prescribing to increase access to contraceptives through pharmacist training, engagement of regional champions, and collaboration across state agencies. This case study highlights North Carolina’s approach to supporting pharmacist training on prescribing hormonal contraceptives.
North Carolina’s Pharmacist Prescribing Policy
North Carolina law authorizes the state health director to issue a standing order allowing pharmacists to prescribe, administer, and dispense certain preventive medications. In 2021, the state health director issued a standing order related to pharmacists prescribing hormonal contraceptives, which was adopted as a state protocol by the North Carolina Board of Pharmacy and the North Carolina Medical Board. The protocol outlines the requirements for pharmacist prescribing of hormonal contraceptives, including a patient assessment consistent with the U.S. Medical Eligibility Criteria for Contraceptive Use, requirements for patient education at the time medication is dispensed, and notification of the patient’s primary care provider. The North Carolina state protocol also notes that pharmacists who provide contraceptives in accordance with these protocols must complete the North Carolina Hormonal Contraception Training Program.
Dispensing Requirements for North Carolina Pharmacists
North Carolina’s protocol for pharmacist prescribing of hormonal contraceptives outlines the requirements that apply to all contraceptive methods prescribed and dispensed by a pharmacist:
- Maintain a patient profile that includes any medications provided under this authority.
- Notify a patient’s primary care provider within 72 hours of dispensing a hormonal contraceptive. If the patient does not identify a primary care provider, direct the patient to information about the benefits of having one.
- Provide records of prescription to the patient or the patient’s primary care provider on request.
- When a hormonal contraceptive is dispensed, counsel the patient about preventive care, including well-woman visits, sexually transmitted infection testing information, and pap smear tests.
- Provide the name, address, phone number, and fax number of the pharmacy on any communication with a prescriber/primary care provider.
- Provide the name of the prescribing pharmacist who dispenses, delivers, or administers medication under this authority on any communication with the provider.
Pharmacist Training for Contraceptive Care Prescribing in North Carolina
Pharmacists in North Carolina are required to complete a five-hour training to be eligible to prescribe hormonal contraceptives, covering topics that include patient health and safety, administration of transdermal hormonal contraceptives, and billing for consultations. The state Board of Pharmacy, in collaboration with the North Carolina Association of Pharmacists (NCAP), developed an online training program for pharmacists interested in prescribing contraceptives. The training content was informed by focus groups and key informant interviews and developed in collaboration with other states that have implemented pharmacist prescribing of hormonal contraceptives.
The University of North Carolina (UNC) School of Pharmacy has also integrated prescribing hormonal contraceptives into its curriculum to educate future pharmacists on the clinical and operational aspects of prescribing hormonal contraceptives. Additionally, the UNC School of Pharmacy is working closely with the state’s Department of Health and Human Services (DHHS), NCAP, and the Board of Pharmacy to track the number of pharmacists in North Carolina who have completed the online training and the number of pharmacies using the protocol to prescribe hormonal contraceptives. The North Carolina Association of Pharmacists has a map and list of participating pharmacies. These collaborative efforts to support pharmacist training and implementation of the state protocol among DHHS, UNC School of Pharmacy, Board of Pharmacy, and the state Association of Pharmacists is supported by grant funding from the Duke Endowment.
Role of Regional Champions
As North Carolina has operationalized the state protocol authorizing pharmacist prescribing of hormonal contraceptives, DHHS and the UNC School of Pharmacy have engaged regional champions to support pharmacists using the authority. Regional champions are pharmacists who choose to provide technical assistance to peer pharmacists and troubleshoot challenges in implementation. Regional champions are asked to encourage pharmacists in their local communities to use this authority and to provide guidance on how to complete the training requirements.
Key Considerations for States Exploring Pharmacist Prescribing of Hormonal Contraceptives
North Carolina’s approach to training and supporting technical assistance for pharmacists related to prescribing hormonal contraceptives may be informative for states that are implementing or are considering implementing pharmacist prescribing policies. States may want to consider strategies such as developing accessible training modules, collaborating with schools of pharmacy, and engaging pharmacist champions to increase awareness of the authority.
Acknowledgments
This case study was written by Dakota Staren. Several NASHP staff contributed to the case study through input, guidance, or draft review, including Anna Lipton Galbraith and Karen VanLandeghem. NASHP extends its thanks and appreciation to the North Carolina Department of Health and Human Services for their input and review.
This work is made possible through generous support from Arnold Ventures.
