Pharmacist-prescribed birth control: a victory for the GOP?

Oregon is the first state to offer hormonal contraceptives without a doctor's prescription. More states may join as Republicans try to combat a "war on women'" image. 

Could 2016 be the year of over-the-counter birth control?

In Oregon, it almost is. On January 1, the state became the first in the nation to allow women to purchase hormonal contraception directly from a pharmacist, without a doctor's prescription. The move is the goal of many doctors and medical associations who say that easier access to birth control is key to improving women's health and reducing poverty. 

They share that vision with an increasing number of politicians on both sides of the aisle, especially as the GOP fights against Democrats' insistence that Republicans are waging a "war on women" by limiting access to abortions and reproductive health services state by state. 

But partisan arguments over cost and coverage may derail attempts to bring the change to more states, leaving Oregon and California, which expects to enact similar laws in the coming months, the only exceptions for now.

In both states, buying the contraceptives won't exactly be an over-the-counter process, but it will typically be a one-stop transaction: Women seeking a hormonal birth control method, such as contraceptive pills or patches, will fill out questionnaires about their medical history. After reviewing their answers, trained pharmacists can prescribe the medication directly. Oregon will require patients under 18 years old to seek their first prescription from a doctor. 

Many doctors applauded the effort, saying the efficiency of the process will encourage more women to seek contraception. New guidelines recommend that women be screened for cervical cancer every three years, rather than every year, making it less important to bring patients into the office, they say.

"There’s a growing body of evidence that there isn’t a safety concern," researcher and University of Calfornia at San Francisco professor Daniel Grossman told the New York Times.

The American College of Obstetricians and Gynecologists has supported over-the-counter birth control since 2012, but with the condition that contraceptives be covered by health insurance.

In Oregon and California, they are. But many of the politicians eager to expand over-the-counter access are Republicans, and less likely to insist on free coverage: most over-the-counter drugs, of any type, are not covered by insurance plans. 

It's one of several points that have led to rival proposals in Congress, where Washington Senator Patty Murray, a Democrat, and Republican Senators Cory Gardner, of Colorado, and Kelly Ayotte, of New Hampshire, have put forward competing bills.

Senator Murray hopes to expand insurance to cover pharmacists' birth-control prescriptions, while the Republican-backed bill would incentivize drug companies to pressure the Food and Drug Administration to approve them. The bill would not require insurance to pay for the medications.

Some hope that a Republican name on a contraception bill would erase public impressions that the GOP is an "anti-woman" party. Some voters have criticized the GOP for limiting reproductive health access and abortion rights. Such criticism of the Republican party became particularly pointed during last  year's debate over defunding Planned Parenthood when videos were publicized that appeared to show Planned Parenthood representatives agreeing to sell fetus parts for profit.

Several states investigated the organization, which primarily provides contraceptives and sexually transmitted infection screening, and found no wrongdoing.

The Supreme Court's decision to exempt Hobby Lobby Arts & Crafts Stores from the Affordable Care Act's requirement that employers' insurance cover employees' contraception further fostered a perception of conservatives as anti-contraception: The company's owners argued that their religious beliefs should exempt them from having to pay for methods such as emergency contraception, or "Plan B," which is available in pharmacies. This year, the Court will hear cases from other organizations, who claim that third-party payments for their workers' birth control violates their religious freedom. 

But claims of a Republican "war on women" predate the latest controversies, and picked up steam in the 2012 elections. That's when Louisiana Governor Bobby Jindal fought back with a Wall Street Journal op-ed, calling for "The End of Birth-Control Politics."

"As a conservative Republican, I believe that we have been stupid to let the Democrats demagogue the contraceptives issue and pretend, during debates about health-care insurance, that Republicans are somehow against birth control," he wrote, arguing that women should not have to see a doctor to get a prescription. 

Mr. Jindal opposes abortion, and believes that no one should be forced to offer contraception, especially to minors. 

And those are yet more sticking points for some politicians and doctors, who believe age limits and ID requirements limit the most vulnerable women's ability to seek care. (In Oregon, pharmacists who do not wish to prescribe birth control must refer patients to another provider.) Others, like Planned Parenthood Action Fund's Executive Vice President Dawn Laguens, say that easier access to prescriptions, while important, is not a quick fix for reproductive rights.

"If Cory Gardner and others were serious about expanding access to birth control, they wouldn’t be trying to repeal the no-copay birth control benefit, reduce Title X funding for birth control, or cut women off from Planned Parenthood’s preventive health services," she wrote in a 2014 statement.

Others insist that birth control should be genuinely over-the-counter. "My basic tenet is there should be nobody between the patient and the pill," Dr. Mark DeFrancesco, president of the American Congress of Obstetricians and Gynecologists, told the New York Times. 

But for now, some politicians on both sides of the aisle are calling the Oregon law a step forward, with or without partisan rancor. 

"I feel strongly that this is what’s best for women’s health in the 21st century, and I also feel it will have repercussions for decreasing poverty because one of the key things for women in poverty is unintended pregnancy," Republican Oregon state Representative Knute Buehler told the Times. 

Editor's note: An earlier version of this story quoted an article published by the Seattle Times. The article, "States Lead Effort to Let Pharmacists Prescribe Birth Control," was originally published by the New York Times. 

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