May 23, 2012

Morning-After Pill: What States Require Dispensing
or Allow Refusal?

So-called "refusal clauses" or "conscience clauses" have been on the legal books for nearly 40 years, since the U.S. Supreme Court's decision in the Roe v. Wade case establishing that most laws against abortion violate a constitutional right to privacy. Those laws usually applied to doctors and other direct providers of health care who might want to opt out of participating in an abortion.

With the approval of drugs such as the so-called "morning-after pill" as well as contraceptives, the focus more recently has turned to pharmacists, according to a recent report from the National Conference of State Legislatures.

Here's what is so confusing for pharmacists: Some states explicitly grant pharmacists the right to refuse to dispense drugs related to contraception on moral grounds. Governor Sam Brownback just signed such a law in Kansas. Other states that give pharmacists refusal rights include Arizona, Arkansas, Georgia, Idaho, Mississippi, and South Dakota. Colorado, Florida, Illinois, Maine, and Tennessee have broader refusal clauses that do not specifically mention pharmacists.

In Arizona, Governor Jan Brewer took it a step further and signed a law this month, saying that a "religiously affiliated employer" will no longer be required to include contraceptive coverage in health insurance policies offered to employees.

On the other hand, Illinois passed an emergency rule that requires pharmacists to dispense any FDA-approved contraception. In California, pharmacists have a duty to dispense prescriptions and can only refuse to dispense a prescription, including contraceptives, with the approval of an employer and with the knowledge that the woman can still get a prescription in a timely manner. New Jersey has a similar but even broader law; it prohibits pharmacists for refusing to fill prescriptions solely on moral, religious, or ethical grounds.

In the state of Washington, pharmacists are allowed to dispense emergency contraception without a prescription through collaborative practice agreement and state-approved protocols. That state, along with Wisconsin, also requires that emergency departments dispense emergency contraception upon request.

U.S. Pharmacist Social Connect