Bill allowing pharmacists to prescribe birth control raises concerns

A measure that would allow Indiana pharmacists to prescribe contraceptives is moving through the General Assembly amid serious objections from the Catholic Church and many health care practitioners.  

House Bill 1568 would grant pharmacists the authority to prescribe and dispense hormonal contraceptives including birth control pills and patches to women at least 18 years old who complete a self-screening.

Proponents argue that passage of the legislation would expand access to what they consider necessary health care, while also providing conscience protection for pharmacists who object on moral grounds to prescribing and dispensing contraceptives. At the same time, the Indiana Catholic Conference (ICC) and others raise concerns regarding both moral and ethical considerations and potential risks to women’s health.

“We have concerns with this bill on a lot of levels,” said Angela Espada, executive director of the ICC, the public policy voice of the Catholic Church in Indiana. “We have objections from Catholic social teaching about contraception, along with serious concerns about a woman’s health. Pharmacists are highly educated and skilled professionals, but they wouldn’t necessarily know a woman’s medical or family history or how these hormones would affect her. This is clearly not the same as having a personal relationship with a doctor.”

Currently in Indiana, only physicians can prescribe contraceptives. If House Bill 1568 passes the General Assembly and becomes law, Indiana would join approximately half of the states in extending prescribing rights for those products to licensed pharmacists.

The bill, authored by Rep. Elizabeth Rowray (R-Yorktown), passed the House 86-12 and at press time was scheduled for a March 22 hearing in the Senate Health and Provider Services committee. The ICC has been meeting with lawmakers to request adding language to the bill requiring pharmacists to also provide information about Natural Family Planning (NFP) during their discussions with patients if the measure becomes law.  

“We are working very hard to get information about NFP – natural, non-invasive, non-pharmaceutical methods – included in this legislation,” Espada said. “If pharmacists can prescribe contraceptives, they can also give out information about NFP.”

NFP, which is fully supported by the Catholic Church and highly effective when used correctly, encompasses several scientific methods that track a couple’s fertility to help achieve or postpone pregnancy. In discussions with lawmakers, the ICC is also advocating for insurance coverage of NFP training and materials.

Kelli Lovell, a trained NFP practitioner who is also a licensed pharmacist, brings a unique perspective to the legislation before the General Assembly.

Lovell has worked as a pharmacist in Evansville for 16 years and has witnessed growth in her profession, including the authority for pharmacists in Indiana to now prescribe diabetic testing supplies and smoking cessation products. But she has significant concerns about House Bill 1568 and its implications.

“I’m pro-pharmacist prescriptive authority in the appropriate circumstances,” said Lovell, a graduate of the Purdue University College of Pharmacy. “This is not what I think is an appropriate circumstance. That’s not because I don’t think that pharmacists can do it, but because I don’t think they should do it.

“I don’t think it gives the right message to the public that this medication is so benign and so safe that you can have somebody who doesn’t even know you prescribe it to you in a five-minute counseling session.”

Lovell says she is grateful that House Bill 1568 includes a conscience protection clause for pharmacists who have moral objections to prescribing and dispensing contraceptives. Still, she acknowledges the tension that this legislation poses for a practicing Catholic who also has the utmost respect for professionals in her chosen field.

“The biggest conundrum is being put in this position where you feel like you have to go against the advancement of your profession because of a moral standard, and I’m going to go with the moral standard every time,” said Lovell, a member of Good Shepherd Catholic Parish in Evansville.

A trained practitioner in both the Creighton and Marquette models of NFP, Lovell also points to the well-established medical risks of artificial contraception, including the potential for blood clots and other side effects.

“Women’s bodies are not meant to be under that level of steroid-based synthetic hormone,” she said. “Simply put, contraceptives are not good for women. They go against natural law.

“The contraceptive pill when used as a contraceptive is the only time in medicine that we would prescribe a medication to disable a functioning system of the body in the absence of disease.”

Dr. Andrew Mullally, a Catholic physician who operates a pro-life family practice office in Fort Wayne, shares numerous concerns about both the medical and ethical ramifications of House Bill 1568.

“The lack of medical supervision is concerning just because patients do not appreciate the intricacies of many medications, and birth control in particular,” Mullally said. “Birth control definitely poses risks for blood clots. It also can interact with other medications. No one would be watching for this, and it would likely get missed at other medical appointments because it’s not something that was prescribed by the patient’s physician.”

Mullally noted similar objections to the legislation raised by the Indiana State Medical Association (ISMA).
“It’s clearly bad just from a secular medical perspective,” said Mullally, a member of both the ISMA and the Catholic Medical Association.

Supporters of the legislation view it as a means of serving a larger number of women in Indiana, especially in smaller communities with limited access to primary care doctors. They also argue that it would reduce the number of unwanted pregnancies, particularly following last year’s legislation restricting abortion in the state.

But the ICC offers a much different view.

“The Church is opposed to this legislation due to the risk to women’s health, unborn life, and the false narrative behind this bill: that increased access to contraception leads to fewer abortions,” said Alexander Mingus, associate director of the ICC.

Mingus points to extensive Catholic social teaching on the subject, particularly St. Pope John Paul II’s groundbreaking encyclical “Evangelium Vitae,” or “The Gospel of Life.” This document, arguably the best-known and most-quoted affirmation of the Catholic Church’s moral teaching on the sanctity of life, includes numerous arguments against artificial contraception.
One especially serious concern involves instances in which hormonal birth control can actually serve as an abortifacient – that is, a drug that could cause an abortion by preventing the implantation of a fertilized egg.

“As a pharmacist, I think all of this is really dangerous,” Lovell said. “If it was going to be done well, if we were going to meet the goal that the bill says it is to meet – to give women better access – it needs to be with significant amounts of education.

“I just think women deserve better,” she continued. “If people see passage of this bill as a big win for women, then they sadly have very low expectations of health care.”

To follow this and other priority legislation of the ICC, visit www.indianacc.org. This website includes access to ICAN, the Indiana Catholic Action Network, which offers the Church’s position on key issues. Those who sign up for ICAN receive alerts on legislation moving forward and ways to contact their elected representatives.