Iowa could move birth control 'behind the counter'

Some health care professionals unsure about legislation

A selection of birth control tablets available at Clark's Pharmacy and Gifts, 1946 42nd St. NE, in northeast Cedar Rapid
A selection of birth control tablets available at Clark’s Pharmacy and Gifts, 1946 42nd St. NE, in northeast Cedar Rapids, Iowa, on Monday, April 8, 2019. (Jim Slosiarek/The Gazette)

Under a proposal introduced to the State Legislature by Gov. Kim Reynolds this year, women in Iowa could obtain birth control at a pharmacy without a prescription from their doctor.

Described by medical professionals as “behind the counter,” the measure would tell the medical director of the Iowa Department of Public Health to issue a standing order on the medication, allowing its sale to any adult.

Medication would include birth control pills, hormone patches and vaginal rings.

“The goal is to expand access,” said Sen. Mariannette Miller-Meeks, R-Ottumwa, and an ophthalmologist with Great River Health System. “If you make it easier for women to have oral contraceptives, you lower the rate of unplanned pregnancies.”

State senators voted to pass the legislation last month. A similar bill on the House side awaits a floor debate.

“Anything we can do to prevent unintended pregnancies, we should look at it,” said Gov. Kim Reynolds in a statement following the Senate vote. “... The policy makes sense, and it’s the right thing to do.”

But due to unanswered questions on the proposed law, some medical providers are hesitant to embrace the new policy in their own practices

Craig Clark, owner of Clark’s Pharmacy in Cedar Rapids, is one pharmacist who said he will not participate in the measure until he knows more about the process.


“I’m just not there,” Clark said. “I need to know more about (the proposal) before I take it on.”

According to the American College of Obstetricians and Gynecologists, or ACOG, oral contraceptives are the “the most widely used” family planning method in the United States.

“Access and cost issues are common reasons why women either do not use contraception or have gaps in use,” according to ACOG.

Dr. Marygrace Elson, president of the Iowa Medical Society and an obstetrics and gynecology clinic professor at the University of Iowa Hospitals and Clinics, said she supports the measure as a low-risk method to expand access to hormonal contraceptives.

Elson said the risk associated with oral contraceptives is “significantly less” than risk associated with pregnancy.

Women on birth control pills are most frequently screening for increased risk of clots in the deep veins — the chance for clots in a pregnant woman is two times more than with pills, she said.

Some prescribers — including physicians, physician assistants and others with prescriptive authority — are concerned the standing order means women will be less likely to visit their doctor for annual exams or other screenings.

“The important thing is that women should still pursue health screenings and immunizations,” Elson said. “Just because they can get birth control more easily doesn’t mean they don’t need to attend to preventive health at all.”


However, to obtain the medication, women would be required to undergo a health screening from the pharmacist before obtaining the medication.

“If a pharmacist sees high or undue risks of using the medication, they will be able to indicate to the woman seeking the medication they need to see a doctor,” Sen. Miller-Meeks said.

Iowa Pharmacy Association Executive Director Kate Gainer said the association also supports the proposal, in part for the opportunity it presents in allowing pharmacists to expand into patient care.

This move could expand access to contraceptives in rural areas, where residents may not have access to a nearby health care provider but do have access to a pharmacy, supporters say.

Supports also say the law would allow pharmacists to practice to the top of their licenses, but in partnership with a patient’s physician.

“Pharmacists don’t want to provide care in a silo, they want to be part of a team,” Gainer said.

However, some pharmacists are still hesitant. Clark, the Cedar Rapids pharmacy owner, said the practice may be best left up to providers.

“To be honest, don’t know I want to take that responsibility away from the (doctor),” Clark said. “I think this still needs to be in the doctor’s realm.”


But Clark also admitted he initially was against providing other services traditionally offered in a doctor’s office.

“Back in the early days, I was not sure about giving flu shots, and now we give all sorts of immunizations,” he said.

Lawmakers say the contraceptives — whether it’s a pill or the patch or a ring — would be covered by the patient’s insurance.

However, Gainer with the Iowa Pharmacy Association said insurance companies would not be required to cover the cost of the health screening itself. For pharmacists, that means the time they spend with a patient one on one would not be paid for.

“We know from other states there is a 20- to 30-minute interaction between pharmacist and patient,” Gainer said. “We do believe (it’s) important for the pharmacist’s time to be paid by insurance as a professional service fee.” Clark, whose pharmacy is independently owned, said the cost of the product would not be enough to cover the time spent with the patient.

“From a business standpoint, it would be stupid for me to do something for 30 minutes to get reimbursed nothing for it,” Clark said.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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