Pharmacies as an Access Point for Expanding Contraceptive Care: A Geographic Analysis
KFF identified examples of counties where access could be improved most from the passage of pharmacist prescribing laws, expanded clinic funding, and pharmacist uptake of prescribing laws.
Pharmacist Prescribing Law Could Expand Access
Lee County, Alabama, with one Title X clinic and no federally qualified health centers, has the most women of reproductive age living under the FPL per clinic of any county in the US. Lee County is a HRSA designated Medically Underserved Area and, according to a George Washington University US Prescription Contraception Workforce Tracker, only has 87 contraceptive prescribers to 41,324 total women of reproductive age. These prescribers are defined as primarily obstetrician/gynecologists (OBGYNs), family medicine physicians, and advanced practice nurses who have provided at least 10 total prescriptions for the pill, patch, or ring. Alabama does not have a pharmacist prescription law; however, if a law were passed, it is estimated that the nearly 30 pharmacies in Lee County could help bridge the contraceptive prescriber gap (Figure 7).
The Role of The Indian Health Service
Many of the counties that have no or low access to pharmacies are those with a high population of American Indian and Alaskan Native people, a historically underserved and marginalized population. In these places, Indian Health Service clinics provide much, if not all, of the contraceptive care options offered to the community. McKinley County, New Mexico and Apache County, Arizona, are neighboring counties in two states that both have pharmacist prescribing laws (Figure 8). In these counties, however, pharmacy uptake would not help address their medically underserved area designation nor expand access to contraceptive care, simply because there are not enough pharmacies in those communities to do so. These counties and similar counties would need additional clinic service sites, rather than expanded pharmacy uptake, to improve access to contraceptive care for women with low incomes.
Pharmacist Prescribing as A Stopgap Measure
Montgomery County, Tennessee has many more pharmacies than clinics (Figure 9). According to the GW Tracker, Montgomery County has 152 total prescribers to a total of 51,180 women aged 15-44. Tennessee’s pharmacist prescriber law went into effect in 2019 — the same year the prescriber data starts. However, there were no pharmacists prescribing at least 10 prescriptions for the pill, patch, or ring in Montgomery County in 2022. Low participation could be because of low uptake of pharmacists in prescribing and dispensing contraception, lack of participation of pharmacies in offering this service, or low consumer awareness or interest in using the services. The legislation alone has not been enough to expand the number of contraceptive prescribers in the county.
