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Access to emergency birth control often isn't timely

May 19, 2003|Trudy Lieberman | Special to The Times

For more than a year now, California women have been able to get emergency contraceptives without a prescription -- in theory.

A state law allowing pharmacists to dispense the pills, which prevent conception within 72 hours of unprotected intercourse, is aimed at limiting unwanted pregnancies and, therefore, abortions. But some medical groups, such as the California Medical Assn. and the American College of Obstetricians and Gynecologists, say the law has created some barriers for women seeking help. Many who need the drugs, they say, are unable to get them.

Only 670 of the 5,200 or so pharmacies in the state have signed agreements with physicians allowing them to dispense the drugs -- a number the California Pharmacists Assn. attributes to the newness of the law. Furthermore, pharmacies that dispense the pills often add a $20 to $40 "consulting" fee to the drug, which retails for $25 to $30.

Pharmacists say the fees are justified because they're spending 15 to 20 minutes with each patient. But Joan Hall, a Sacramento lobbyist for the gynecologists' group, says pharmacists don't charge such fees for other drugs. "This is a highly discriminatory and predatory practice," she says. "Women have to get these drugs in a certain amount of time, and these prices act as barriers."

Those most affected by the fees are poor women who may not have a doctor they can call for a prescription or a an insurer to pay the bill. Many pharmacies say they don't charge consulting fees for women with prescriptions.

But what most angers women's groups and medical organizations is a one-page questionnaire that many pharmacists are requiring women to fill out before they can buy the pills. The questionnaire is not required by law, nor is it necessary to obtain traditional birth control pills. It asks women details about their last menstrual period, whether they want condoms or information about sexually transmitted infections, whether they might have such an infection and whether they want a referral to a doctor.

The one-page list of 11 questions was created by an Oakland-based group called Pharmacy Access Partnership along with state and national pharmacy associations. The partnership is funded by several foundations that seek to further access to contraceptives and give pharmacies a stronger role in promoting community health. Its director, Jane Boggess, says that by collecting the information, pharmacies will be able to make future referrals for care.

Women's organizations, gynecologists' groups and the California Medical Assn. say most of the questions are not relevant to whether women need emergency contraceptives. "It was not the intent of the law to make pharmacists into public health officials," says Shannon Smith-Crowley, a lobbyist for the medical association. "What information do they really need to gather?" Gynecologists say the pharmacists need to know only if a woman has had unprotected sex in the last 72 hours and if she is allergic to any medications.

The pharmacy association says the questionnaire is necessary to make sure women are appropriate candidates for the drugs. Carlo Michelotti, chief executive of the California Pharmacists Assn., defends the questionnaire, saying pharmacists need information about patients since no prescription is necessary and that they need to ensure that women know what they're getting. He denies that it's intrusive, adding that the information is confidential. "It's a huge turf issue," he says. "If pharmacists are doing consulting without a doctor's intervention, they are treading on the turf of nurses and physicians."

The fight has reached both the state and the federal levels. In the California Legislature, Sen. Jackie Speier (D-Hillsborough) is sponsoring a bill that would let pharmacists dispense emergency contraceptives without taking special training, prohibit them from charging a consultation fee, and limit dispensing fees to $3.55, the amount they can charge to fill prescriptions for Medi-Cal patients. The bill does not prohibit the questionnaire but states that pharmacists do not have a duty to maintain special patient-medication records.

The Food and Drug Administration is expected to rule within the year on a petition by the manufacturer of one of the drugs, Plan B, to make the drug available over the counter. (The other drug is called Preven.)

The battle over fees and forms reflects the ongoing public struggle over women's reproductive rights and who ultimately has control -- the woman, outside organizations or the marketplace. "It's about discrimination that exists in reproductive health for women," Speier says.

Men don't fill out questionnaires or pay consulting fees to obtain Viagra.

Speier says there's a history of discrimination in California, from the time contraceptives weren't covered by health maintenance organizations to insurance surcharges for labor and delivery (the surcharges were outlawed last year).

But it's also about money. Michelotti says druggists don't want the Legislature telling them what they can charge and that if they can't charge consulting fees, they simply won't sell the drugs.

If that happens, women's reproductive rights will be compromised yet again.


Trudy Lieberman can be reached at Health Matters runs on the third Monday of the month.

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