U.S. Bill Would Enforce Contraceptive Access in Pharmacies

April 14, 2005

Todd Zwillich

April 14, 2005 — Washington lawmakers introduced a bill Thursday making it illegal for pharmacies to refuse to fill prescriptions for birth control, fueling a growing controversy over whether pharmacists have the right to withhold oral contraceptives from patients with valid prescriptions.

Under the "Access to Legal Pharmaceuticals Act," introduced by Democrats in the House and Senate, pharmacists who refuse to fill any prescription because of "personal beliefs" must ensure that another dispenses the drugs. Pharmacies that do not stock a drug must order it immediately at the patient's request, it states.

Pharmacies can be fined up to $5,000 per day or $500,000 total for delays in providing drugs, the bill says.

Physician-Patient Relationship

While the bill applies to all prescriptions and does not specifically mention contraception, supporters made it clear that it was intended to head off a growing number of pharmacists who are refusing to fill prescriptions for birth control and emergency contraceptives because of moral objections.

"Nobody has the right to come between a person and their doctor," said Sen. Frank Lautenberg (D-N.J.), the bill's chief senate sponsor. "We just want to have a bill that will say, 'pharmacists, do your job, period,' " he said.

The bill comes a day after two Illinois pharmacists sued Democratic Gov. Rod Blagojevich over a new state rule compelling pharmacies that carry contraceptives to fill prescriptions for birth control.

The rule also forces pharmacies that do not stock the requested pills, including emergency contraception, to order them or refer the patient to a nearby pharmacy. Gov. Blagojevich enacted the rule April 1 after two Chicago pharmacists refused to fill prescriptions for emergency contraceptives.

Similar refusals have occurred in at least seven states, including Texas, where in 2004 three Eckerd pharmacists in the town of Denton allegedly refused to fill an emergency contraceptive prescription for a rape victim.

"We have to make sure that women do not have to fight through the conscience of their pharmacist in order to get legal prescription drugs," said Rep. Debbie Wasserman Schultz (D-Fla.), a House sponsor of the bill.

The bill does not require pharmacies to stock any drug but only compels them to order it for patients with a valid prescription, aides said.

Conservative Pharmacists Respond

Kern Brauer, RPh, president of Pharmacists for Life International, a conservative pharmacists' group with 1,600 members, challenged the bill in an interview, saying it would be unenforceable because some pharmacists refuse to provide birth control pills on medical safety grounds.

"First they'll have to prove that the denial [to fill a prescription] is due to beliefs. I think we could make the government go broke trying to enforce that," she said.

At least four states — Arkansas, Mississippi, South Dakota, and Georgia — have laws or regulations giving pharmacists the right to refuse to fill prescriptions to which they morally object.

Other states are considering legislation requiring pharmacists to fill all valid prescriptions.

Controversy over oral contraceptives also surfaced last week on Capitol Hill. Then, two Democratic senators blocked the confirmation of President Bush's pick to head the Food and Drug Administration (FDA) until the agency issues a long-awaited decision on whether to allow the emergency contraceptive Plan B to be sold over the counter to patients aged 16 years and older.

The Senate Health, Education, Labor, and Pensions Committee was scheduled to vote Wednesday on Lester Crawford's nomination but cancelled the vote at the last minute. Administration officials said that the vote was cancelled after the committee received an unspecified complaint about Dr. Crawford from an anonymous FDA employee, the newspaper Congressional Quarterly reported.

Details of the complaint were not made public.

Reviewed by Gary D. Vogin, MD

Todd Zwillich is a freelance writer for Medscape.

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