It will still be several months until West Virginia women are able to access birth control at a pharmacy without a prescription from a doctor, even though the law that made it possible went into effect in June.
The Family Planning Access Act (House Bill 2583) was passed this legislative session with the intent of increasing access to self-administered contraception — like the pill, the patch or the ring — and in turn, hopefully decreasing the amount of unintended pregnancies in the state. It will allow women age 18 and older to receive birth control prescriptions directly from pharmacists instead of through a general practitioner or doctor’s visit.
The bill was signed into law by Gov. Jim Justice in March and officially went into effect on June 7, but there are still quite a few months worth of work to be done by state health officials before women will benefit from it, said Krista Capehart, staff pharmacist at the West Virginia Board of Pharmacy who worked to pass the bill and is helping draft protocols and parameters for its implementation.
“We realize how important this is to the people in West Virginia and we know a large portion of pregnancies in West Virginia are unplanned, so we want this to be a public benefit,” Capehart said.
In 2015, the most recent data available, 43 percent of pregnancies in West Virginia were unintended, according to a report released last May by the state Department of Health and Human Resources.
Capehart said the earliest date for the new policies to be implemented will be by January 2020. “And that’s really pushing it ... that would be like ‘Wow, everybody is on their game and making everything work as it should,’ ” he said.
The delay is not unusual — nine other states, as well as the District of Columbia, have policies on their books allowing pharmacists to prescribe birth control, but it takes time to nail down details and ensure that services are offered in the best interest of the patients. Some states have taken as long as two years after passage to get the policy implemented, Capehart said, but she does not think it will be that long for West Virginia.
“We’re looking at speeding this up — we’re hopeful that between the [Board of Pharmacy] and [the Bureau for Medical Services] we’ll be able to roll this out and have pharmacists trained for the first of the year,” Capehart said. “I think the big thing to recognize is that we’re doing this in the best manner possible — for medical safety and patient safety — but also we’re going to make sure that birth control is as readily accessible as possible, as soon as we can.”
When the policy does go into effect, Capehart said it will closely resemble the process of getting immunizations, like a flu shot, at pharmacies.
Women will walk in, fill out a questionnaire that asks about potential health risks like a history of blood clots, migraines or other conditions that could be exacerbated by contraception, and then a pharmacist — if they deem the patient low-risk and are comfortable doing so — will prescribe a contraceptive that best fits their needs.
Just as if the birth control was a result from a doctor’s prescription, the patient’s insurance will cover whatever plans allow for. They can receive up to a year’s worth of refills for the prescription, then they will need to refer to a general practitioner.
Capehart said the policy is opt-in for all pharmacists, meaning no one will be forced to prescribe birth control if they are uncomfortable doing so. Pharmacists who do want to administer contraceptives will have to undergo a training, paid for themselves, to be educated on the different types of contraceptives, different brands and the potential risks associated with prescribing them.
Currently there are no plans for state dollars to help fund these training sessions, but Capehart said that nationally there are grants to help cover programs like this, and the final costs for training sessions should be relatively affordable.
“Really no more than the trainings for administering immunizations,” Capehart said.
Right now, Capehart, along with DHHR officials, are working out other details for the policy, like what screener questions specifically should be on the questionnaire and if there should be check-ins mandated before the one-year mark, and if so when and how. They are using the policies implemented by a handful of other states to help craft the West Virginia version of the rules, and so far Capehart said she is nothing but confident in what the final result will be.
“They’ve done a good job in other places figuring this out, and we are doing it here,” Capehart said. “We are going to make sure that we’re offering the best care possible, and that there won’t be any reason for someone to worry about receiving a prescription this way.”
If a pharmacist believes a woman may have some complications with contraceptives, they will refer her to her primary care provider, or another facility if she does not have one, Capehart said.
“It’s not like, if you don’t have a doctor you won’t get contraceptives — we’re going to make sure this works for everyone it can,” Capehart said. “That’s the whole point: accessibility.”
Per DHHR, about 6 percent of women in West Virginia who experienced unintended pregnancies in 2015 reported they were not using any form of birth control due to complications accessing it.
This policy, Capehart said, will hopefully reduce that statistic to as close to zero as possible. Also, as unintended pregnancies hopefully decline in the state, so will the costs — both health and monetary — associated with them.
Almost 70 percent of women aged 18-49 are at risk for unintended pregnancies in West Virginia, according to the Centers for Disease Control. Of those women, 22 percent are not on any form of birth control.
When unintended pregnancies do occur, they can mean billions of public dollars spent on anything from foster care to social welfare programs and Medicaid, according to the CDC’s national vital statistics program.
As an example, from 2009 to 2015, the teen birth rate in West Virginia dropped from 50 per 100,000 women to 32 per 100,000 women, bringing with it $14 million in savings for the state, per the CDC.
Unintended pregnancies also come with health risks for both mothers and babies. According to the CDC, women who experience unintended pregnancies are less likely to access prenatal care that can help ensure healthy pregnancies. Mothers are also two times more likely to suffer from postpartum depression after an unintended pregnancy, compared to after a planned pregnancy, per the CDC.
Babies born from unintended pregnancies are at a significantly higher risk of dying in the first few days of life, and are about 67 percent more likely to be born with low birth weights, per the CDC.
West Virginia already holds relatively high rates for both infant mortality and babies born with low birth weights.
The state ranks 12th highest in the U.S. for infant mortality rates, with 7 per 100,000 babies dying at birth or not long after in 2017. The state also ranks 6th highest for babies born with low birth weights, with 27 per 100,000 babies classified as such in the same year.
Capehart said that, as those working on the policy creep closer to implementing it, there will be a public education portion of the roll-out to explain the benefits of increasing access to birth control and of decreasing the number of unintended pregnancies.
She also wants to ensure that people understand the policy will not be an “over-the-counter” method, like with buying ibuprofen where there is no contact necessary with anyone knowledgeable in health care.
“They’re going to be trained, diligently, and they’re going to do what’s best for the health of the person in front of them, that’s the bottom line,” Capehart said. “It’s by no means going to be a free-for-all.”
While the current iteration of the Family Planning Access Act only allows for the prescription of self-administered birth control methods to adult women, age 18 and up, Capehart said there is certainly the chance of expanding and tweaking the law as time passes.
Several legislators this session tried to get the bill to cover birth control for those under 18, but were voted down in the amendment stages of the bill’s readings. This does not mean, though, that sometime in the future it will not be possible, Capehart said.
There’s also a possibility of pharmacists being able to prescribe wider forms of birth control later on, like contraceptive injections, which are hormonal shots administered every few months. Capehart said other states have included these in their laws, and it’s not an impossibility here, depending on how lawmakers treat the legislation in future years.
For now, Capehart and other health officials are just working on making sure the current version of the law will be practiced to the best of pharmacists’ abilities, in the best interest of women using their services.
“This is, you know, it’s kind of landmark for West Virginia,” Capehart said. “It’s an important move for us in improving women’s health care and being a little innovative in the way we offer these services. We’re going to make sure we do it right.”