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Questions remain as California allows pharmacies to dispense birth control without prescriptions

LOS ANGELES » When her daughters were younger, Lori Herman wished there had been an easier way to get them birth control.

“It’s such a hassle to get the kid in to see the OB/GYN,” said Herman, a systems analyst who lives in Simi Valley.

Now there is. Girls and women in California now can pick up hormonal contraceptives, including pills and patches, at pharmacies without first visiting doctors.

Supporters of the change, which took effect today, say requiring an annual doctor’s visit creates unnecessary barriers to contraception and that easing access could reduce unintended pregnancies.

But Herman said that both of her daughters experienced side effects, including headaches and nausea, when they began taking birth control pills. She had to take them to the doctor repeatedly to get the problems diagnosed and find new contraceptives to try, she said.

If a pharmacist were handing out contraceptives, she asked: “How would they deal with that?”

Many people are raising questions about the new system, in which girls and women of any age in California no longer need doctors’ prescriptions to get certain types of birth control. California is the third state to allow women to obtain hormonal birth control directly from a pharmacist, though many more states are considering similar legislation.

Dr. Deepjot Singh, head of the obstetrics and gynecology department at Torrance Memorial Medical Center, said about half her patients who begin taking birth control must switch to other kinds within a year.

When they come in complaining of unexpected bleeding, acne or weight gain, she must consider the effects of each drug and counsel each patient. Depending on the problem, she might have to do a physical exam, she said.

“That’s a medical visit,” Singh said. “A pharmacist cannot replace a physician.”

She said she was worried that patients would miss out on important medical advice or lose the opportunity to have a problem diagnosed by a doctor if they instead relied on a pharmacist. She wants to make it easier for women to obtain birth control, she said, but would prefer if doctors initially helped patients find the best ones for them, after which pharmacists could renew those prescriptions.

Supporters of California’s new law, however, say pharmacists have as much, if not more, knowledge of drug side effects as physicians do. When the law was debated in Sacramento, it faced little opposition.

Plus, pharmacists can and will refer women to doctors if there are questions they can’t answer, or they think patients require medical counseling, said Kathleen Besinque, a clinical pharmacy professor at the University of Southern California.

“The point isn’t that women have to go to a pharmacy, it’s just one more option,” said Besinque, who helped write the law.

Many public health advocates and doctors say birth control is extremely safe and point to studies that show that women can generally choose one that works well for them. The American Congress of Obstetricians and Gynecologists, the largest group representing OB/GYNs, supports legislation that would make birth control truly over-the-counter.

In Oregon and Washington, pharmacists can dispense birth control to women. Representatives of the Washington Medical Association, which represents doctors, say the practice, which has been allowed for more than 30 years there, has caused no problems.

Some physicians worried that patients on birth control would try to self-diagnose their problems on the Internet and choose a new kind based on nonscientific recommendations. Others were worried that women would start birth control to try to cure other problems — it’s often used to treat acne, for example — without consulting doctors first.

The California Medical Association opposed the state’s law originally but switched its stance to neutral after a provision was added requiring pharmacists to screen patients.

Before dispensing the hormones, pharmacists must take a patient’s blood pressure and administer a questionnaire covering medical issues that could cause problems. High blood pressure increases the chance of strokes or blood clots. But Harrison said she thinks that California’s questionnaire won’t catch people who haven’t received medical care before and don’t know their medical risk factors.

Though California’s law took effect today, most pharmacies won’t dispense birth control over the next few days. They’re not required to participate under the law, and representatives of pharmacies like CVS said they were either still preparing or waiting to review the final regulations.

Insurance companies should cover the cost of birth control picked up at pharmacies, though it’s possible that pharmacists could charge for furnishing the birth control. That service cannot be billed to insurance.

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©2016 Los Angeles Times

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