You asked what states have physician and pharmacist collaborative practice laws permitting pharmacists to dispense emergency contraceptives without first requiring the patient to see a physician.

SUMMARY

We have identified seven states with laws allowing a pharmacist to dispense emergency contraceptives to a patient without first requiring her to see a physician. In all cases, the pharmacist acts under the authority of a written protocol with a prescribing physician that sets the conditions for his actions.

Four of the states have laws specific to emergency contraceptives: California, Maine, Massachusetts, and New Hampshire. All require a pharmacist to be specifically trained on emergency contraception, act in accordance with a protocol with a prescribing physician, and provide specific information to the patient, including the need for follow-up medical attention.

The laws of Alaska, New Mexico, and Washington allow a pharmacist to exercise collaborative practice authority with physicians. The laws in Alaska and Washington do not mention emergency contraceptives, but they presumably apply to it. The law in New Mexico has emergency contraceptive provisions.

ALASKA

Alaska authorizes a pharmacist to exercise collaborative practice authority by initiating or modifying drug therapy in accordance with a written protocol with a prescribing physician. The protocol must be submitted to and approved by the Board of Pharmacy before it may be implemented. The authorization is not restricted to emergency contraceptives.

The protocol must include:

1. an authorization to administer or dispense drugs;

2. an identification of the physician and pharmacist;

3. its duration, which may not be more than two years;

4. the types of decisions being authorized, such as the types of diseases, drugs, or drug categories involved and the procedures, decision criteria, or plans the pharmacists must follow;

5. how the pharmacist will carry out his duties under the protocol, including record keeping;

6. a specific list of types of eligible patients;

7. a plan for the practitioner to review the pharmacist's decisions; and

8. a plan to provide the physician with each patient record created under the protocol (12 Alaska Admin. Code § 52. 240).

CALIFORNIA

California authorizes a pharmacist to provide emergency contraception drug therapy in accordance with either a protocol developed by the pharmacist and a physician or a standardized protocol developed by the Medical Board of California in consultation with the American College of Obstetricians and Gynecologists, the California Pharmacist Association, and others. Before providing emergency contraceptives, a pharmacist must complete a training program.

The law prohibits a pharmacist from requiring a patient to provide individually identifiable medical information beyond what is normally required of patients filling prescriptions. It requires a pharmacist to give a document stating the indications for use, appropriate method of use, the need for medical follow-up, and other information (Cal. Bus. & Prof. Code § 4052).

MAINE

Maine authorizes a pharmacist to initiate emergency contraception drug therapy in accordance with a protocol developed by the pharmacist and a prescribing practitioner. It requires a pharmacist (1) before initiating the therapy, to complete a training program on emergency contraception provided by an organization authorized by a national council on pharmaceutical education or approved by the pharmacy board and (2) to give the patient a document stating indications for use, appropriate method of use, the need for medical follow-up, information on sexual assault, and other information (Me. Rev. Stat. T. 32 § 13824).

MASSACHUSETTS

Massachusetts authorizes a pharmacist to dispense emergency contraceptives in accordance with a protocol developed by a physician registered to prescribe controlled substances. It requires a pharmacist (1) before dispensing emergency contraceptives, to complete a training program on emergency contraception approved by the public health commissioner, which must include proper documentation, quality assurance, referral to additional services, and appropriate recommendation that the patient obtain follow-up medical services and (2) report annually to the public health department on the number of times emergency contraceptives are dispensed (Mass. Gen. Laws Ch. 94C § 19A).

NEW HAMPSHIRE

New Hampshire authorizes a pharmacist to initiate emergency contraception drug therapy in accordance with a protocol developed by the Pharmacy Board. It requires a pharmacist (1) before dispensing emergency contraceptives, to successfully complete emergency contraception drug therapy education in accordance with continuing education requirements established by the board and (2) to give the patient a document stating indications for use, appropriate method of use, the need for medical follow-up, and health care referral information (N. H. Rev. Stat. 318: 47-c).

NEW MEXICO

New Mexico requires the Board of Pharmacy to adopt regulations implementing its Pharmacist Prescriptive Authority Act. The board has adopted regulations setting requirements for pharmacists who exercise their prescriptive authority to prescribe emergency contraception drug therapy. Pharmacists must successfully complete a training course on emergency contraception accredited by the Accreditation Council for Pharmacy Education and provided by the state, Planned Parenthood, or a pharmacy board-approved organization. The course must include:

1. mechanisms of action, contraindication, and monitoring of emergency contraception therapy;

2. standards;

3. indications for use;

4. patient interview;

5. patient counseling;

6. evaluating the patient's medical profile for drug interaction;

7. patient referral for follow-up care by a medical provider;

8. informed consent;

9. record management; and

10. management of adverse events.

A pharmacists' exercise of prescriptive authority must be exercised in accordance with a written protocol for emergency contraception drug therapy approved by the pharmacy board (N. M. Stat. §61-11B-1 et seq. , N. M. Admin. Code § 16. 19. 26. 1 et seq. ).

WASHINGTON

Washington authorizes pharmacists to exercise prescriptive authority in accordance with a written protocol established by a prescribing physician. The protocol must identify the pharmacist and practitioner, authorize specific prescribing functions, and not last longer than two years (Wash. Admin. Code § 246-863-100 et seq. ).