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New Md. birth control law treats pharmacists as providers

Natalie Eddington

‘The pharmacist is the expert on medication,’ said Natalie Eddington, dean of the School of Pharmacy at the University of Maryland, Baltimore. ‘Not the nurse. Not the physician. The pharmacist.’ (The Daily Record/Maximilian Franz)

Pharmacists in Maryland will be able to prescribe birth control under a new Maryland law, another step as they gain more abilities to act as providers of medical care.

At a time when the medical community is concerned about disparities of care, especially reaching urban and rural communities that often lack access to care, pharmacists say they can be a trusted local medical professional.

“I think it’s catching on because community pharmacies in our communities are an infrastructure point of access to care for our communities,” said Natalie Eddington, dean of the University of Maryland School of Pharmacy. “Your pharmacist is in the CVS and Rite Aids and Walgreens of our country at least 12 hours a day.”

In various states across the country, pharmacists have also received increased ability to administer and dispense naloxone, administer vaccines and prescribe tobacco cessation medication.

Nationally, a bipartisan bill in Congress would allow pharmacists to be reimbursed for care given to Medicare patients in cases where pharmacists help with drug management. But that bill has not gained traction in the face of opposition from groups like the American Medical Association.

Getting care through a pharmacist doesn’t necessarily equate to quality care, said Gene Ransom, executive director MedChi, Maryland’s medical association.

“We have serious health disparities all over this country,” he said. “Those are real problems. But the way to solve them is not to give them lower-level providers or stopgap measures. … Giving someone substandard care is not access to care.”

But the opioid crisis could prove to be an exception where pharmacists and doctors are on the same page.

“The next step, from my perspective as a dean and what I see, I think it needs to be how do we address the opioid crisis in our state,” Eddington said. “Thirty other states allow pharmacists to administer naloxone to their patients that have a problem with opioids.”

Last year, the Maryland Department of Health and Mental Hygeine issued an order allowing certified pharmacists to dispense naloxone without a prescription.

Ransom doesn’t have a problem with pharmacists administering naloxone because of the state’s opioid crisis. But there could be problems with allowing pharmacists to provide birth control, he said.

“They’re not primary-care providers and should not be prescribing,” he said. “You don’t want to set a precedent of pharmacists as primary-care physicians.”

If patients get their contraceptives prescribed by a pharmacist, they would miss out on an appointment with their doctor, where their larger medical history could be considered.

“Then the problem is what about the next drug and the next drug,” Ransom said. “You want people having discussions with their primary-care physician about their entire medical condition.”

But pharmacists believe their knowledge of the drugs makes them qualified to pitch in as providers, especially after four years of specialized education and clinical experience.

“The pharmacist is the expert on medication,” Eddington said. “Not the nurse. Not the physician. The pharmacist.”

Under the bill passed by the Maryland legislature last month and allowed to become law without the governor’s signature last week, the state Board of Pharmacy must create regulations and guidelines for the prescription of birth control by pharmacists by September 2018. Prescriptions cannot begin until Jan. 1, 2019.

Similar laws have been passed in California and Oregon.

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