Arizona approves prescription-free birth control

Arizona women are now able to visit their local pharmacy for their birth control needs without first securing a doctor’s signature. 

A law passed two years ago that finally made it through official hurdles last week removes the requirement for a doctor-approved prescription to buy hormonal contraceptives, including the pill, vaginal rings and patches. 

“It’s an exciting move forward for women’s health,” said Kam Gandhi, executive director of the state’s pharmaceutical board. 

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Arizona joins more than 20 other states that have similarly eased access to birth control. And demand for contraceptives in the Grand Canyon State is high, with as much as 71% of sexually active women aged 18 through 49 using some form of birth control, according to a 2019 study. The pill was the second most popular option

But the new law comes with some caveats. 

A valid form of identification must be presented because minors aren’t allowed to obtain the medication. A risk assessment questionnaire and blood pressure test must be completed prior to receiving the contraceptives to help determine which type is safest for the patient. 

And not all pharmacies offer the service. The law isn’t mandatory, so pharmacies can choose whether or not to participate and existing Arizona law allows even individual pharmacists to refuse to dispense drugs if they feel their religious or moral beliefs about reproduction would be violated. 

The Arizona Department of Health Services recommends that interested Arizonans call ahead to ensure their local pharmacy is both equipped and willing to provide contraceptives without a prescription. 

Heather Ross, a spokeswoman for the Arizona Nurses Association, celebrated the law’s implementation, calling it a win for more equitable health care access. Scheduling a doctor’s appointment isn’t an easy task for everyone, she said. 

“For a lot of people, it may be a far drive, and transportation can be an issue for people negotiating a work schedule or childcare availability,” she said. 

Opponents of the law worried that eliminating the need for a doctor’s signature would result in women receiving potentially dangerous drugs or skipping critical check-ups. To assuage the first concern, the questionnaire, which includes a section on medical history, was added to the law to identify patients at risk of experiencing blood clots who shouldn’t be given contraceptives with high estrogen levels. 

And while Ross acknowledged that easier access to contraceptives introduces a tradeoff, she said that the benefits of expanding care outweigh the drawbacks of forfeited doctor’s appointments. Women who were able to make the time to visit the doctor’s office in the past are likely to continue doing so, she added. 

“We expect that people who could visit a health care provider and get that full check-up are probably still going to do that,” she said. “What this is doing is really expanding access to birth control for people who weren’t able to get that full check-up in the first place.” 

That difference in access is particularly keen for Dr. Katherine Glaser, an OB-GYN who works in rural Arizona. 

“I practice in Northern Arizona, where clinics are about 75 miles apart in any given direction,” she said. “We have a pretty good access time, it’s maybe only a couple of weeks for people. But if you’re factoring in transportation time and fuel costs, that can be another burden.” 

Glaser, who is also a member of the Arizona Medical Association, which supported the underlying bill, noted that while the new law significantly eases the strain on some, it still isn’t perfect. The age threshold and identification requirements, in particular, threaten to leave out minors who are sexually active and trying to take precautions or immigrant women without valid forms of identification. 

Women who are eligible to receive contraceptives under the new law have the option to receive a 12-month supply, something which Glaser expects women will take advantage of, especially if they’re worried about the state’s future stances on reproductive health care. Currently, abortion access in Arizona is restricted by a 15-week gestational limit passed last year, but an 1864 near-total ban is still on the books and seeing a renewed effort from anti-abortion groups to reinstate it.

“Anything that we can do to increase access to contraceptives is helpful,” Glaser said. “Last summer, as Arizona had an on-again off-again climate for abortion access, we saw a lot of concern and a lot of people seeking long-acting reversible contraceptives such as the IUD or the implant so that they would know they had effective contraception for years in case of whatever may come along as far as legislation.” 

Implant or IUD contraceptives, which provide protection for three years or more, can only be administered by licensed doctors. 

Administrative hurdles

On July 6, a day after her regulatory review council greenlit the rulemaking required to finally launch the new law, Gov. Katie Hobbs touted it as another example of her promise to protect reproductive health care in the state. 

“We are building an Arizona for everyone, which means ensuring people across the state have what they need to live a free and healthy life,” she said in a written statement. 

While some criticized her announcement as an attempt to co-opt actions she had no hand in, others pointed out that it took over two years to implement the law. But,  Gandhi said the delay likely had more to do with the derailing effects of COVID-19 than with the Ducey administration’s reticence. 

“Two years is pretty lengthy, it typically doesn’t take that long. I would say, worst case scenario, it could take up to a year,” he said. 

In March, the Arizona State Board of Pharmacy filed a notice of rulemaking docket opening, the first step in developing rules around a law’s implementation. Even beginning the process requires the governor’s written approval. At the board’s request, the Governor’s Regulatory Review Council made its final approval of the rules effective immediately, bypassing the usual 60-day waiting period. 

Federal solutions

While a standing order from the Department of Health Services allows women to purchase contraceptives without a doctor’s OK, it doesn’t make them accessible in the way that Plan B is. The emergency contraceptive is currently the only form of hormonal birth control that is truly over-the-counter, accessible to anyone regardless of age and without the need for a doctor’s signature. 

Action at the federal level, however, could change that. 

In May, advisors to the Food and Drug Administration unanimously voted 17-0 to recommend that Opill be approved for over-the-counter use. The contraceptive pill is progestin, not estrogen based, meaning it doesn’t pose the same issues for women who face an increased risk of blood clots. The vote isn’t binding, but it gives the FDA the option to approve the contraceptive’s widespread use. A final decision is expected sometime this summer. 

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