The Effect of Pharmacy Scope of Practice Regulations on Healthcare: Evidence from Contraceptive Prescribing

• In Event: Reproductive Care at the Margins: Abortion, Contraception, and the Consequences of Access

Abstract

In recent years, healthcare delivery has shifted to address challenges related to access across healthcare broadly, but particularly in the realm of contraceptive healthcare. As one example, “pharmacy access” laws authorize pharmacists to independently prescribe hormonal contraceptives under their own prescriptive authority rather than that of a prescribing physician. These policies have been widely implemented over the past decade—increasing rapidly during the COVID-19 pandemic—with 29 states authorizing pharmacists to dispense hormonal contraceptive pills, the patch, the ring, and the shot. Yet, research on whether these policies have changed contraceptive use is unknown.

In this study, we examine the effect of these laws on prescription contraceptive use. To do so, we leverage an all-payer, longitudinal prescription and clinical claims database containing the entirety of all observed claims for each individual from 2010-2023. Of the 433,732 unique individuals in the data, we use records of over 200,000 women of childbearing age (15-40 at the start of the sample) and observe 2,432,952 claims related to prescription contraceptives. We pair these data with information on state-level pharmacy scope-of-practice regulations and a staggered difference-in-differences approach. We find that these policies increase the likelihood of using any contraceptive by 1.05 percentage points. Relative to the baseline mean contraceptive use rate, this reflects an increase of about 7%. These results hold when using recently developed estimators that account for the staggered implementation of the policy across states.

Barriers to hormonal contraception have been a significant policy problem in the U.S., where almost half of pregnancies are not planned, and a lack of access to contraceptive care is associated with higher maternal mortality rates, higher health care costs, and poorer outcomes in the health of mothers and children. For example, as many as 30% of women in the U.S. report difficulty “obtaining, filling, or refilling” a prescription, which is typically required to access hormonal contraception. Pharmacists are among the most accessible health professionals for patients on a day-to-day basis. Unlike other medical institutions, pharmacies are generally housed alongside fixtures of daily life, not only as standalone pharmacies but also within grocery stores and drugstores, making them both more accessible and convenient for patients. The results from this study inform the potential role of pharmacists in reproductive healthcare access and delivery, implying that increasing their prescribing authority leads to more contraceptive use.

Author

• Nicole Y Siegal, Indiana University
  Presenting Author