Boston Business Journal | Viewpoint: CVS, Walgreens should follow Mass. contraception law
By Rebecca Hart Holder, President of Reproductive Equity Now
Op-ed originally appeared in Boston Business Journal
Two of the largest retail pharmacy chains in the country — CVS and Walgreens — have both made major public commitments to “become a certified pharmacy” to dispense medication abortion, a mark of corporate leadership that we expect to have significant impacts on people’s ability to access abortion care in protected states like Massachusetts. This promising announcement comes after a Food and Drug Administration regulatory change Tuesday to allow prescription medication abortion to be dispensed at certified pharmacies, a decision that left many wondering whether pharmacies would take the proactive steps to become certified to dispense this medication in the first place.
CVS and Walgreens are making a clear and swift commitment to expanding reproductive health care access and helping to normalize abortion as part of health care. Now, as the retail pharmacy chains prepare to certify their pharmacies to dispense mifepristone — the first of two medications taken in a medication abortion regimen — I can’t help but remind CVS and Walgreens that there is more they can and should be doing to expand access to all types of reproductive health care. Reproductive health care is more than just abortion care, and it’s time that these pharmacies take long overdue action to implement a 2017 Massachusetts law regarding the dispensing of contraception, too.
The ACCESS law, now in effect for more than five years, intends to make contraception more accessible and affordable by requiring all state-regulated Massachusetts insurers to cover FDA-approved contraceptive methods — including birth control, IUDs, and emergency contraception — with no copay. Passed in response to then-President Trump's threat to gut the Affordable Care Act (ACA), it codified the ACA's contraceptive provision at the state level. But our law goes further, allowing consumers to access up to a year’s supply of birth control at once and ensuring coverage of emergency contraception when dispensed under a standing order.
Unfortunately, implementation of this law has been plagued by lack of knowledge and communication breakdowns, in part by pharmacies like CVS and Walgreens. Half a decade after passage of the law, Bay Staters — including my own staff — continue to come to Reproductive Equity Now with difficulty accessing a year’s supply of birth control and frustration trying to navigate the complicated landscape of insurance and prescription medication. Every time a person cannot access the full year’s supply of contraception allowed by this law at the pharmacy counter, trust in our healthcare system erodes — unless pharmacies step up.
A lack of knowledge by pharmacists should not stand in the way of people’s ability to access the medication they need. Pharmacy chains have a duty to educate individual pharmacists about the Massachusetts ACCESS law. This means knowing that patients may ask for a year’s supply of birth control and knowing that fully-insured plans will cover it at no cost. It also means knowing that pharmacists in Massachusetts may dispense a year’s supply of birth control, even if a prescription is not explicitly written as such, so long as there are sufficient refills prescribed. Importantly, pharmacies must also ensure proper inventory to be able to fill these prescriptions.
Because so few pharmacies proactively entered into individual standing orders for emergency contraception following passage of the ACCESS law, the Massachusetts legislature passed a statewide standing order for both over-the-counter and prescription emergency contraception as part of their historic response to the overturn of Roe v. Wade this summer. DPH swiftly issued the standing order in August — now, all that’s left is to make sure retail pharmacies implement it properly.
CVS and Walgreens must not only take steps to dispense mifepristone, but also update their operating procedures and ensure that Bay State pharmacists actually know that they can dispense either over-the-counter or prescription emergency contraception pursuant to the standing order. Patients on fully-insured plans must be able to visit their pharmacy counter and access the emergency contraception that is right for them without paying out of pocket. Retail pharmacy chains have a responsibility to get this right, especially in a post-Roe world.
It’s excellent that these pharmacies are taking steps forward to dispense medication abortion, but how can we ignore the fact that a Massachusetts law to make contraception more affordable and accessible has fallen to the wayside? Now, with both an unapologetically pro-choice legislature and governor for the first time in eight years, these pharmacies must understand that Massachusetts is serious about expanding access to reproductive health care. That includes birth control and emergency contraception, too.
Rebecca Hart Holder is president of Reproductive Equity Now.