NC pharmacists can now dispense birth control without a prescription. How it works.
A new state law that went into effect on Feb. 1 allows North Carolinians access to birth control, as well as several other medications, directly from a pharmacist without a doctor’s prescription.
But the provisions within the law did not become operational until Monday, March 14, when State Health Director Dr. Betsey Tilson issued “standing orders” for how pharmacists should implement the law.
The law expands pharmacists’ scope of practice by allowing immunizing pharmacists to “dispense, deliver or administer” certain nicotine replacement therapies, oral or transdermal (or patch) contraceptives, prenatal vitamins, post-exposure prophylaxis medications and glucagon.
With the standing orders now signed by Tilson, pharmacists have more direct instructions for dispensing the contraceptives listed in the law, and required training will be available to further equip them for the task.
Standing orders for the other medications listed in the law have not yet been issued.
To learn more about how you can receive the birth control options listed in the law from a pharmacist, The News & Observer consulted Tilson’s standing orders and talked with Jay Campbell, executive director of the North Carolina Board of Pharmacy.
Here’s what we learned about the process North Carolinians should follow to access these medications from a pharmacist.
Which medications are included in the law?
The law allows immunizing pharmacists to dispense, deliver or administer the following medications:
▪ Nicotine replacement therapy that is approved by the U.S. Food and Drug Administration (FDA).
▪ Self-administered oral or transdermal contraceptives. Oral contraceptives are ones taken by mouth (also known as “the pill”). Transdermal contraceptives are ones administered through a patch placed on the skin (also known as “the patch”).
The law does not allow pharmacists to dispense, deliver or administer a specific form of emergency contraception known as ulipristal acetate without a prescription from a licensed prescriber. Other forms of emergency contraception, such as Plan B One-Step, are already available over-the-counter in North Carolina, and the new law does not not affect access to those products.
Ring, injection and implant forms of birth control are not covered under the law and cannot be administered by pharmacists.
▪ Prenatal vitamins
▪ Post-exposure prophylaxis (PEP) medications for the prevention of human immunodeficiency virus (HIV). Pharmacists issuing these medications should follow guidelines and recommendations from the Centers for Disease Control and Prevention (CDC).
▪ Glucagon for the treatment of severe hypoglycemia.
Note: Standing orders for the non-birth control medications listed in the law have not yet been issued. When they are issued, they should be available at ncpublichealth.info/HDSO-pharmacists.htm.
What is an immunizing pharmacist?
The new law specifically allows immunizing pharmacists to dispense the medications outlined in the law.
As outlined in guidance from the N.C. Board of Pharmacy, an immunizing pharmacist is a pharmacist who, in North Carolina, meets the following certifications and requirements:
▪ They hold a current provider level cardiopulmonary resuscitation certification issued by the American Heart Association or the American Red Cross, or an equivalent certification.
▪ They have successfully completed a certificate program in vaccine administration accredited by the Centers for Disease Control and Prevention, the Accreditation Council for Pharmacy Education or a similar health authority or professional body approved by the state Board of Pharmacy.
▪ They maintain documentation of three hours of continuing education every two years. The continuing education requirements are designed to maintain competency in the disease states, drugs and vaccine administration.
▪ They have successfully completed training approved by the Division of Public Health’s Immunization Branch for participation in the North Carolina Immunization Registry.
▪ They have notified the North Carolina Board of Pharmacy and the North Carolina Medical Board of their immunizing pharmacist status.
▪ They administer vaccines or immunizations in accordance with North Carolina law.
These requirements for immunizing pharmacists are the same as they were before the new law went into effect. The new law expands the scope of practice for immunizing pharmacists, but did not change the requirements pharmacists must meet to having immunizing status.
The standing order adds an additional requirement for pharmacists to administer birth control — they must complete the North Carolina Hormonal Contraception Training Program.
▪ The North Carolina Association of Pharmacists is producing this training program, which will be available online to up to 6,000 pharmacists over the next year, according to the state Board of Pharmacy.
▪ Because the training program is still in development, it may delay when pharmacists can administer birth control, as they must complete the training before they can do so.
How to know if your pharmacist is an immunizing pharmacist
There’s generally not a badge or other outward indicators that a pharmacist is an immunizing pharmacist, Campbell said, so it’s best to ask your pharmacy or pharmacist directly whether they are an immunizing pharmacist.
Campbell said pharmacies will likely be more open about whether their pharmacists are immunizing pharmacists under the new law — they’ll want customers to know whether they’re offering these new services — but if you’re not sure, or you don’t see communication from your pharmacy about it, it won’t hurt to ask.
“I think the key is, as in all things, establish a good working relationship with a pharmacist or a pharmacy, and have those conversations with them directly,” Campbell said.
Who is eligible to receive birth control under the law?
The standing orders issued specifically for the contraceptive medications listed in the law outline criteria for who is eligible to receive birth control from a pharmacist.
To receive birth control from a pharmacist:
▪ You must be a person of “reproductive age” who voluntarily requests contraception, and is at risk of experiencing an unintended pregnancy, but who is currently, “within reasonable certainty,” not pregnant.
▪ You must receive consent from a parent or guardian if you are under 18.
▪ You must complete a patient questionnaire that your pharmacist will evaluate using criteria listed in the standing orders. The questionnaire includes questions about methods of birth control you are currently using, medical history and more.
▪ You must have a pharmacist-measured, seated blood pressure reading less than or equal to 140/90. If your blood pressure is too high on the first reading, the pharmacist may wait five minutes and take the measurement again. If the reading is still too high, the pharmacist is directed to not dispense birth control to you and instead refer you to a medical provider.
How do I get birth control from a pharmacist under the law?
The standing orders lay out a step-by-step guide for pharmacists to dispense birth control under the law.
▪ The pharmacist must first review your insurance coverage and how you wish to pay for the birth control they dispense. If you do not have insurance and do not wish to pay out-of-pocket, they should refer you to free reproductive health services in your community.
▪ The pharmacist must then review your primary care provider information. If you do not have a primary care provider, the pharmacist is advised to provide counsel to you on the benefits of establishing primary care and direct you to information about primary care providers near you.
▪ The pharmacist will then take your blood pressure. If your blood pressure reading is too high, the pharmacist will refer you to a primary care provider or other medical provider.
▪ The pharmacist will review your height and weight, which is self-reported by the person seeking birth control in the patient questionnaire.
▪ The pharmacist will review your birth control status and history, as provided by you in the patient questionnaire. If you prefer a birth control that pharmacists are unable to prescribe due to their scope of practice, they will refer you to another medical provider.
▪ The pharmacist will complete a screening to be reasonably sure you are not pregnant. The screening will be based on the answers you provide in the patient questionnaire, and a self-administered pregnancy test may be required depending on your answers to some questions.
▪ The pharmacist will review your medical history. Depending on your answers to some questions, you may be referred to another medical provider.
▪ The pharmacist will review your medication history. Depending on your answers to some questions, you may be referred to another medical provider.
▪ If your screening is completed and you were not referred to another medical provider, the pharmacist will complete a documentation form and dispense your preferred form of birth control that is covered under the law.
Additional steps pharmacists must take under the law
The law outlines several steps pharmacists must take when dispensing, delivering or administering the medications included in the law.
When the pharmacist give a patient access to a medication, they must:
▪ Maintain a patient profile that includes any medications provided under the law’s authority.
▪ Notify a patient’s identified primary care provider with 72 hours of providing the medication to the patient. If the patient does not identify a primary care provider, the pharmacist should direct the patient to information about “the benefits of having one.” This protocol is similar to the requirement for pharmacists administering vaccinations.
▪ Provide records to the patient or the patient’s primary care provider when requested.
▪ If a hormonal contraceptive is dispensed, the pharmacist should “counsel the patient about preventative care, including well-woman visits, sexually transmitted infection testing information and Pap smear testing.”
▪ Provide the name, address, phone and fax of the pharmacy on any communication with a prescriber or primary care provider.
▪ Provide the name of the immunizing pharmacist who dispenses, delivers or administers medication under the law on any communication with the primary care provider.
How does insurance come into play under the law?
The step-by-step care pathway provided to pharmacists in the standing orders outlines several options for paying for the birth control your pharmacist dispenses.
▪ If you have insurance, you may be able to use it to cover the cost of pharmacist-dispensed birth control. Check with your insurance provider to see if this is covered.
▪ Whether or not you have insurance, you can pay out-of-pocket for pharmacist-dispensed birth control.
▪ If you do not have insurance, and do not want to pay out-of-pocket for pharmacist-dispensed birth control, the standing orders advise pharmacists to refer you to free reproductive health services in your community for lower-cost options.
The standing orders advise pharmacists to consider the most cost-effective options for each payment scenario.
Additional resources for receiving birth control under the law
More information about the new law and the associated standing orders can be found at the following websites:
▪ North Carolina Department of Health and Human Services: ncpublichealth.info/HDSO-pharmacists.htm
▪ North Carolina Board of Pharmacy: ncbop.org
▪ North Carolina Association of Pharmacists: ncpharmacists.org
This story was originally published March 15, 2022 at 2:56 PM with the headline "NC pharmacists can now dispense birth control without a prescription. How it works.."
