Inviting the pharmacist: a model for improved reproductive care access

Editorial / Contraception 85 (2012) 2–43legislation that enables pharmacists and medical providers toenter into collaborative agreements [6]. These collaborations,when fully utilized, are a terrific example of how toestablish a patient-centered medical home that is inclusive ofpharmacists. Patients in traditional allopathic medicalpractices, not open on weekends or after hours, now haveimmediate access to contraceptive care and vaccinations.Think of patients who need access to their 3-month Depo-Provera injection or their second and third HPVvaccination, yet cannot get to a clinic during traditionalbusiness hours. Think also of a 20-year-old patient whoneeds EC on a weekend but the OTC product is out of reachfinancially. A pharmacist prescribing this EC rather thanselling it OTC can bill the patient's insurance without thepatient deductible or co-pay [7].3. Barriers and solutions to accessAccess to reproductive and sexual health care isdetermined by many factors. Among the influences affectingboth consumers and providers are age, geographic location,personal reproductive health literacy, family, money,insurance, culture, religion, country, public policy, healthsystem fragmentation, provider time constraints, productavailability, local and national standards of care, peerpressure, the time of day, the day of the week and urgencyof need. Each of us has the ability to positively impact one ormore of these access issues — pharmacists are no exception.Uniquely placed in small towns and in inner cities, theirwalk-in access, their extended hours and their clinicaleducation put pharmacists in a position to impact access toreproductive health in ways that may be inherently difficultfor other providers to attain on their own.Successful pharmacy partnership solutions may involve,but are not at all limited to, the following examples:• Pharmacists engaged as consultant partners or asprofessional staff members/employees in reproductivehealth clinics and school-based health centers. Theseprimarily nondispensing pharmacy partnerships supportkey health messages to patients, assist ineliminating medication issues (i.e., refills, insurance,drug interactions, adherence, etc.) and help clinics tomeet or exceed their ever-increasing quality assurancerequirements [8].• Pharmacists, using collaborative agreements with localphysicians or Advanced Registered Nurse Practitioners,initiating hormonal contraception as a briefbridge for women without ready access to a medicalprovider [5]. Long-acting reversible contraception maybe the ultimate objective for many women, butcontraception initiated at the pharmacy may be avital temporary solution. Pharmacists using collaborativeagreement protocols with local medical providerscan establish formal referral pipelines for cancer, rapeand sexually transmitted infection screenings, not tomention improving access to EC and hormonalcontraception pills, patches, rings and injectables.• Development of youth-friendly pharmacies to helpyouth access objective reproductive health informationand to help facilitate medical referrals. The PharmacyAccess Partnership program, supported by reproductivehealth visionaries such as Dr. Felicia Stewart,Dr. Jane Boggess, Belle Taylor-McGhee, Dr. PhilipDarney and Sharon Landau, among others, has helpedus to better understand the reproductive healthaccess needs of youth and the role that enlightenedpharmacists can play in removing access barriers.Advocates for Youth in Washington, DC, continuesthis work by embracing pharmacists as key reproductivehealth partners.• Pharmacists providing Depo-Provera injections, asstated previously, after initial evaluation by a medicalclinician. HPV injections can similarly be provided,and there may be additional opportunities for collaborationwith other important adherence medications.• Pharmacists stocking free or low-cost contraceptivesacquired from local clinics or by 340B purchasingagreements, a national medication discount programdesigned for patients of Federally Qualified HealthCenters. This model utilizes medical–pharmacy collaborativeprotocols to provide low- or no-costcontraceptive access to patients who are uninsured orunderinsured. Nonemancipated youth without accessto their parent's insurance can also benefit by thesepharmacy partnerships. Low-income patients needingan urgent refill of their hormonal contraception orperhaps EC can access these services under a specificprotocol even when their medical provider is temporarilyunavailable.• Pharmacists prescribing EC, under a collaborativeagreement protocol, to undocumented immigrants andwomen under 17 years of age needing a prescriptionfor EC. Currently, this can only happen in the ninestates with pharmacist authority to initiate EC careservices, but many other states could be added to thelist. Pharmacists prescribing EC under a collaborativeagreement protocol to women 17 years of age andolder who technically have access to OTC EC butrequire EC to be prescribed for insurance coverage.With no co-pay for prescription contraceptives, thiswould eliminate cost barriers for many women.4. Conundrums, compensation and considerationsPharmacists, like other medical providers, have aninherent conflict of interest when they simultaneouslyprovide clinical interventions, yet profit from the sale oftheir own medications. Unfortunately, the compensationmodel for pharmacists is historically dependent on product