UB pharmacy researcher examines benefits of pharmacist-administered injectable contraception

BUFFALO, N.Y. — Approximately 19 million U.S. women of childbearing age reside in what are known as “contraceptive deserts” due to geographic, political, economic and social barriers to birth control. Women living in rural areas are particularly vulnerable.

“This means the local community pharmacy may be the closest or only way for women in these areas to obtain birth control,” noted Nicole Cieri-Hutcherson, PharmD, University at Buffalo clinical associate professor of pharmacy practice. Her research areas include women’s and reproductive health.

Cieri-Hutcherson and a small research team recently conducted a systematic review examining attitudes toward pharmacist-administered injectable contraception, which contains just the hormone progestin, not estrogen, and is reversible. They also looked at the results of this practice in other states and countries, including Canada and the United Kingdom.

The team discovered that most pharmacists, providers and patients considered the injectable birth control option, which has been approved by the U.S. Food and Drug Administration (FDA), beneficial. Their findings were published in the Feb. 15 issue of the Journal of the American Pharmacists Association.

The other researchers included Cieri-Hutcherson’s husband, Timothy Hutcherson, director of the Drug Information Center at D’Youville University, and three D’Youville student pharmacists.

Only long-acting contraceptives available in pharmacy

Currently, women in New York State can get the self-administered pill, patch and ring contraceptives at their local pharmacy but not the pharmacist-administered injectable contraceptive, which lasts for three months.

“This is the only long-acting contraceptive that a woman would be able to obtain at a pharmacy,” Cieri-Hutcherson said. “Other benefits of the injectable contraceptive are that they are dependable, convenient and discrete.”

The New York State Assembly is currently considering allowing pharmacists to administer injectable contraceptives in community pharmacies. The New York Senate has already approved the practice, which is similar to pharmacist-administered vaccines. It does not require a physician’s exam or prescription.

A woman who wants this type of birth control would just need to fill out a questionnaire and have her blood pressure monitored at the pharmacy.

Many states already allow practice

Since 2016, almost half the states in the U.S. as well as Washington, D.C., have approved legislation greenlighting pharmacist provision of certain contraceptive forms, including the ring, pill and patch, and in 10 states, injectable contraception.

This trend is partially in response to the changing landscape of maternal and reproductive health care.

“The role of pharmacists in reproductive health and contraception management continues to expand,” Cieri-Hutcherson said. “Allowing pharmacists to administer injectable contraception in New York would benefit patients while aligning with pharmacists’ capabilities and professional roles.”

Interestingly, New York was one of the last states to offer immunizations inside pharmacies. And now, pharmacists certified by the New York State Education Department can administer long-acting injectable antipsychotic drugs to patients.

Convenient birth control option

While oral hormonal contraceptives remain the most common form of birth control, just 7.5% of women of childbearing age worldwide use an injectable contraceptive.

Cieri-Hutcherson predicts the injectables may gain in popularity over time, considering their longevity and convenience with no daily pill to remember to take.

“I envision it as a good option for women throughout their reproductive years,” she said. “It’s convenient for busy women who can get their three-month dose of birth control while shopping at their local supermarket. It’s also appealing to adolescents who may want a confidential and discrete type of birth control.”

Side effects include weight gain and irregular periods. And if used over longer periods of time, bone loss can occur, she said. New practice guidelines also state there is a slightly increased risk of blood clots compared to other progestin-only contraceptive forms.

Further findings in review

While the study revealed that most pharmacists felt confident and capable of administering the injectable contraceptives, some expressed the need for further training and resources.

“As far as training goes, we want to tell pharmacists that it’s not that different from evaluating for contraindications to and administering a vaccine,” she said. “Pharmacists who are interested would just need to take a two-hour training course. UB is one institution that offers a course meeting the objectives of the standing order in New York.”

Another concern was cost and reimbursement. While New York State Medicaid may be billed for the product and service, not all private insurance will cover it the same way.

“The cost of the service to the patient is at the discretion of the pharmacies, about half of which are independent in New York State,” she said.

While health care providers included in the systematic review supported pharmacist provision of injectable contraception, some expressed concern that if patients don’t come to their office for contraceptives, they won’t come for well visits such as cervical cancer screenings or mammograms — services that are often bundled with contraceptive care.

“Evidence shows that more accessible models are not steering patients away from preventative health screenings,” Cieri-Hutcherson said, pointing to data from California and Oregon showing that almost 90% of women who used pharmacy contraceptive services had visited their primary care provider within the last year.

As for pharmacists’ concerns, she noted that barriers and needs for further trainings should definitely be addressed. “But overall,” she said, “this is an important opportunity to increase access to reproductive health care.”