Short-acting hormonal contraception is the most common form of birth control. This group of contraceptives includes the pill, patch, ring or injections.  

Of those options, 1 in 4 people using birth control rely on the pill. When used correctly, studies show the pill leads to only 3 pregnancies per 10,000 in 12 months of “perfect use.” However, what most call “typical use” involves common occurrences such as a missed dose or delayed refill. Typical use results in closer to 80 per 10,000 pregnancies.  

Researchers know that almost half of users stop taking the pill by the 12-month mark. It may be that they changed their mind or method. However, some of the reasons people stop can include difficulties accessing contraception, such as: 

• Running out of pills 
• Not being able to get a prescription 
• The cost of a refill 

One way to tackle access difficulties is through pharmacy prescription. In this approach, pharmacists can prescribe the contraception, without requiring an appointment or medical visit. 

Seventeen states and the District of Columbia have laws that allow pharmacists to prescribe this kind of birth control. Studies have shown that pharmacists prescribe to some groups in higher amounts: younger women or those without insurance. Pharmacists also prescribe for longer periods. These numbers suggest that pharmacists may be helpful in filling the access void. 

“We wanted to see how effectively people used contraception when it was prescribed by a pharmacist in comparison to when it is prescribed by a clinician,” says Maria I. Rodriguez, M.D., MPH, an OB-GYN and family planning expert at the OHSU Center for Women’s Health, who led the study. “We wondered if pharmacist prescriptions could help get contraception to people who may struggle to access it for any number of reasons.” 

With this in mind, Dr. Rodriguez and a group of OHSU researchers set out to ask two questions: 

1. Is there any difference in continuation of contraception at 12 months between those who received their prescription from a clinician versus from a pharmacist?

2. Does the prescriber type affect how well someone sticks to “perfect use”?  

The researchers looked at 139 pharmacies across 4 states (CA, CO, HI and OR). The pharmacists recruited participants. Those included in the final study: 

• Were women aged 18 to 50 years 
• Had been prescribed at least 1 month of hormonal contraception from a clinician or pharmacist  

• Had completed a 12-month follow-up survey (there were also 3- and 6-month surveys) 

They answered questions about their use of birth control, symptoms and other details. The researchers defined perfect use as never missing a day of contraception, and they tracked who fit in that category and those who fell into typical use. 

Were the results different between pharmacist-prescribed and clinician-prescribed contraception?

Researchers found no difference at the 12-month mark between the groups. The women prescribed birth control by the pharmacists were as likely to continue use at 1 year as those whose prescription came from a clinician (90.4% vs 89.3%). The number of women reporting “no missed days” – perfect use – for the two groups was also very close: 53.8% pharmacists vs 47.0% clinicians. 

The researchers concluded that two groups demonstrated the same effectiveness at “promoting correct and consistent use of contraception.” 

What do these results mean for contraception access?

There are more pharmacies than providers. Pharmacies are located within smaller communities, and they often have longer hours than clinics. They do not require appointments and often have less travel time. These aspects can make pharmacies more accessible than clinics. 

However, it is important to note that cost is still a factor with pharmacy prescriptions. In this study, women receiving contraception from a pharmacist were more likely to pay out of pocket. 

“In the end, contraceptive services in pharmacies improves access to those with barriers to getting a prescription or refill,” says Dr. Rodriguez. “We need to expand these promising services.” 

“We also need to take a good look at insurance coverage,” she adds. “We need to ensure equitable coverage across the board, so that cost does not limit access.” 

Another consideration: Opill is an over-the-counter birth control pill that received FDA approval in 2023. It does not require a prescription. Whether users avoid missed days or continue past the 12-month mark merits investigation once Opill hits the pharmacy shelves.