Pharmacist-prescribed Hormonal Contraception Research Articles

Assessing pharmacist and clinician perspectives on pharmacist-prescribed hormonal contraceptives

BackgroundAfter the Dobbs et al. ruling in June 2022 by the U.S. Supreme Court eliminated the federal right to abortion care, concerns about access to reproductive health have been elevated. Barriers to contraception use consist of knowledge deficits, unfavorable legal rulings, cost and insurance coverage, unnecessary medical practices, and health care inequities. Pharmacists are the most accessible health care providers who are positioned to mitigate these barriers and expand reproductive health access through scope of practice expansion. The American College of Obstetricians and Gynecologists has expressed their support for pharmacists prescribing hormonal contraceptives. As of October 2022, 22 states and jurisdictions have a protocol in place to allow for autonomous prescribing of hormonal contraceptives by pharmacists. ObjectiveThe objective of this study was to simultaneously assess pharmacist and clinician perspectives of all ages and sexual identities, on pharmacist-prescribed hormonal contraceptives and barriers faced in accessing contraception. MethodsThe researchers conducted an institutional review board–approved observational study via a cross-sectional survey distributed to licensed pharmacists and clinicians from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and through e-mail listservs. The survey assessed barriers to contraception access, perspectives toward pharmacist-prescribed hormonal contraception, likelihood of receiving pharmacist-prescribed hormonal contraception, and pharmacist comfort with prescribing hormonal contraceptives. ResultsNearly 38% of respondents reported having ever experienced ≥ 1 barrier in accessing contraception, which were having a time barrier or delay in appointment, a cost or copay barrier, and/or lacking an obstetrician/gynecologist. Eighty-one percent of all respondents agreed or strongly agreed with pharmacist-prescribed hormonal contraception. Sixty-one percent of pharmacists said they are either very or somewhat comfortable prescribing hormonal contraception. Pharmacists’ most commonly reported concerns were payment for services, lack of access to patient medical records, and patient safety. ConclusionsAfter Dobbs et al., most pharmacists and clinicians in Rhode Island support pharmacist-prescribed hormonal contraceptives and the most frequently reported barriers faced in accessing contraception may be overcome through pharmacist prescribing. The information and data gathered from this study supported legislation for pharmacist prescriptive authority for hormonal contraception in Rhode Island.

Implementation of pharmacy access to hormonal contraception

BackgroundStates throughout the country are enacting legislation to authorize pharmacist prescribing of hormonal contraception to decrease barriers to access. Little is known about the process of state implementation of pharmacist prescriptive authority for hormonal contraception. ObjectivesTo understand the state-level steps to enable pharmacist prescribing of hormonal contraception, including implementation challenges and facilitators. MethodsWe conducted a qualitative study of interviews with 18 key individuals, including pharmacists and other stakeholders, from ten states with laws permitting pharmacist-prescribed hormonal contraception from March 2021 to April 2022. We analyzed data using directed qualitative analysis principles and compared experiences across states. We organized the data using the Consolidated Framework for Implementation Research framework and evaluated relevant constructs in states’ implementation efforts. ResultsParticipants identified four key steps to implement pharmacist prescribing at the state level, including development of state rules and regulations, educational programs, reimbursement mechanisms, and expansion strategies to pharmacists and pharmacies. Participants identified early involvement of key stakeholders and a culture of support for clinical pharmacists as facilitators to implementation. Challenges included complexity and cost of billing mechanisms, lack of funding for implementation efforts, and competing priorities of pharmacies/pharmacists. ConclusionParticipants in states with pharmacist prescriptive authority for hormonal contraception identified development of reimbursement and billing mechanisms as the most critical state-level step in implementation. Focusing on facilitators of key steps can guide states in developing successful implementation strategies to improve contraceptive access.

Community perspectives on pharmacist-prescribed hormonal contraception in rural California

ObjectivesIn the United States, numerous states have enabled pharmacists to prescribe hormonal contraception. Little research focuses on the perspectives of potential users of this service in rural communities. This study sought to describe awareness of, interest in, acceptability of, and support for pharmacist-prescribed contraception in a rural California county. Study DesignWe conducted a community-based survey in 2019–20 in Tulare County, California. Researchers partnered with community members to design, implement, and analyze the survey. We recruited respondents who were ages 15 to 44 and assigned female sex at birth, using passive community-based approaches, social media advertisements, and social networks. Analyses focused on 177 respondents with a potential future need for contraception. ResultsThirty-one percent of respondents were aware that pharmacists could prescribe hormonal contraception in California, with more accurate knowledge among older respondents (p = 0.015). After receiving brief educational information about pharmacist-prescribed contraception, respondents expressed high levels of support and acceptability: they perceived pharmacist-prescribed contraception to be safe, time saving, and more convenient. Respondents were more comfortable talking about contraception with traditional contraceptive care providers compared to asking pharmacists questions about contraception. Fifty-seven percent were somewhat or very interested in obtaining contraception from a pharmacist, with higher levels of interest among those who preferred to use a different method. ConclusionAwareness of pharmacist-prescribed contraception in a rural California community was low, though people are supportive of and interested in utilizing this service. This research suggests that increased availability of pharmacist-prescribed contraception could support individuals’ reproductive self-determination and address gaps in access. ImplicationsDespite limited awareness of pharmacist-prescribed contraception, interest in using and community support for this service was high in a rural California community. This analysis suggests that increased availability of pharmacist-prescribed contraception could support reproductive self-determination and address access barriers, particularly for people whose contraceptive needs are not currently being met.

North Carolina Pharmacists’ Support for Hormonal Contraception Prescription Status Change

Background Pharmacist-prescribed hormonal contraception (HC) may offer additional avenues of access for patients; however, it is unknown whether pharmacists would support over-the-counter access to contraception over pharmacist-prescribed models. Objective: The objective of this study was to understand how North Carolina (NC) pharmacists believed HC should be classified and how pharmacist and pharmacy characteristics were associated with those beliefs. Methods: This study was a secondary analysis of a cross-sectional, anonymous, online survey completed by 587 licensed NC pharmacists. The primary outcome of interest was how pharmacists believed HC should be classified: prescription-only, pharmacist-prescribed, behind-the-counter, or over-the-counter. Multinomial bivariate and multivariable regression analyses were conducted to describe the association between pharmacist and pharmacy characteristics with the outcomes of interest through odds ratios and adjusted odds ratios, respectively. Chi-square tests were used to examine the association of geographic location with distribution of attitudes toward HC classification. Results: Fifty-one percent of NC pharmacists supported classification of HC as pharmacist-prescribed, while 23% supported non-prescription (behind- or over-the-counter) classification. Controlling for pharmacist demographics and pharmacy characteristics, completing residency training was significantly associated with supporting pharmacist-prescribed vs prescription-only classification (adjusted odds ratio (aOR) = 2.55, P = .02). Pharmacists had higher odds of supporting pharmacist-prescribed vs prescription-only HC if they agreed that they were well trained to do so (aOR = 3.14, P < .01). Distribution of attitudes about classification of HC did not significantly differ by geographic location (P = .14). Conclusions: Most NC pharmacists support deviating from the current prescription-only classification of HC, with more support for pharmacist-prescribed classification. Continuing education programs should focus on training pharmacists to feel more confident prescribing HC.

Impact of a hormonal contraceptive training program for pharmacists

BackgroundSeveral states have passed legislation allowing pharmacists to prescribe hormonal contraceptives in an effort to expand access to family planning options for patients. ObjectiveThe primary objective of this research is to evaluate participant knowledge and perception, attitudes, and preparedness regarding pharmacist-prescribed hormonal contraception before and after completion of the American Pharmacists Association’s interactive online training program, “Increasing Access to Hormonal Contraceptive Products: A Training Program for Pharmacists.” MethodsTraining program participants were assessed on their knowledge after each module, and they were invited to participate in a pre- and postsurvey about practice environments and opinions related to hormonal contraceptive prescribing. Descriptive statistics were calculated for categorical survey responses, and means and standard deviations were calculated for program knowledge assessment scores. Pre- and postsurvey responses were analyzed using the Wilcoxon signed-rank test or McNemar’s test according to the type of response options. ResultsMore than 450 participants completed the Hormonal Contraception Training Program; 61% completed the presurvey and 39% completed the postsurvey. Participants had an average score of 86% across modules for both surveys. Comfort level increased statistically significantly in all areas surveyed after program completion. Survey results identified statistically significant changes between pre- and postsurvey in the belief that pharmacists are trained and educated to counsel on and initiate hormonal contraceptives (P < 0.001 and P < 0.001) and that prescribing hormonal contraceptives should be within a pharmacist’s scope of practice (P < 0.001). Most respondents (83%) agreed that pharmacy schools should expand content on contraceptive prescribing, although more than half (56%) reported that their pharmacy school taught them the requisite hormonal contraceptive clinical content. ConclusionTraining programs play an important role in preparing pharmacists for prescribing roles by providing knowledge and increasing confidence and generally positively affecting perceptions of and attitudes toward prescribing hormonal contraceptives.

Patient experiences with pharmacist prescribed hormonal contraception in California independent and chain pharmacies

BackgroundPharmacist contraception care is an innovative practice that is rapidly expanding with policy changes. There is limited literature describing patient experiences with this pharmacist service. ObjectiveThe objective of this study is to describe patient experiences using pharmacist-prescribed hormonal contraception in California pharmacies. MethodsAn online survey was conducted among a cross-sectional convenience sample of people of all ages who completed a contraception visit with a pharmacist from December 2017 to January 2019 at a participating independent or chain pharmacy in California. Descriptive statistics were used to analyze data on patient characteristics, experiences and satisfaction with the service, and preventive health screenings. ResultsA total of 160 individuals completed the survey and nearly all were adults (97%) and had started or completed postsecondary education (85%). Most (72%) visited the pharmacy to get a prescription for a contraceptive method they were already using. The most common method prescribed was the pill (90%). The most common reason for seeking a prescription at a pharmacy was because it would be faster than waiting for a doctor’s appointment (74%), followed by the location and hours being more convenient (46% and 41%), saving money (28%), and not having a regular doctor (26%). Respondents reported satisfaction with the services overall (97%), level of comfort they felt with the pharmacist (94%), counseling provided (86%), and level of privacy (74%). Nearly all were likely to return to a pharmacist for contraception (96%) and recommend the service to a friend (95%). ConclusionPharmacist prescribing of contraception in community pharmacies provided a convenient access point that was highly acceptable to patients who used it. One area for attention is in the level of privacy during contraception visits. These findings support the effectiveness of direct pharmacy access to contraception and encourage pharmacist contraception prescribing policies and widespread implementation.

Pharmacist-Prescribed Hormonal Contraception: Does Didactic Hormonal Contraception Education Affect Student Pharmacist Perceptions of This Professional Activity?

Since 2014, select states have allowed pharmacists to prescribe hormonal contraception (HC). This study describes student pharmacists’ perceptions of a pharmacist’s scope of practice, education, and interest, and identifies differences between students who have completed didactic HC content in their professional curriculum versus those who have not. A voluntary online survey was emailed to all students in three Georgia pharmacy schools. Descriptive statistics were reported. Likert square responses were dichotomized, and Chi square testing identified differences between groups. A total of 1256 students were invited, 35% completed the survey, of those 68% had received HC didactic content in their curriculum. Regardless of HC education, most students “agree” or “strongly agree” that pharmacists are adequately educated to prescribe HC (92% vs. 86%, p = 0.05) and prescribing HC is within the pharmacist’s scope of practice (89% vs. 84%, p = 0.12). Although not currently permitted in Georgia, most are interested in prescribing (97% vs. 96%, p = 0.5). Of the students who have received HC didactic content, 87% felt “moderately”, “well”, or “extremely well-educated” regarding HC prescribing clinical skills. Regardless of didactic training, pharmacy students believe pharmacists are prepared to prescribe HC and support pharmacist-prescribed HC as a part of their future professional scope of practice.

Pharmacists’ perspectives and experience prescribing hormonal contraception in rural and urban New Mexico

BackgroundPharmacist prescription of contraception is becoming increasingly common in the United States (US). Limited information exists on whether this is improving access to contraception in underserved areas, including rural America. ObjectiveWe sought to determine whether there were differences by rural location in pharmacists’ willingness to prescribe hormonal contraception and perceived barriers to doing so. MethodsWe conducted a cross-sectional survey of pharmacists eligible to prescribe hormonal contraception in New Mexico in March and May 2020. The survey consisted of demographic data, pharmacists’ experience prescribing hormonal contraception, and questions regarding perceived barriers to pharmacist-prescribed hormonal contraception. Descriptive statistics assessed differences in survey responses between rural and urban pharmacists. We used multivariable logistic regression to estimate the association between rural practice and prescribing hormonal contraception. ResultsOur sampling frame consisted of 822 licensed pharmacists. We received 256 responses, for a response rate of 31.1%. We found that rural pharmacists were as likely as their urban counterparts to prescribe hormonal contraception (adjusted odds ratio 1.22 [95% CI 0.56–2.68], P = 0.50). Five main barriers included a need for additional training, reimbursement for services, liability concerns, corporate policies, and shortage of staff. No difference in barriers were identified by rural location or staff role. ConclusionPharmacy access has the potential to improve access to contraception across New Mexico, including underserved rural areas.

Student pharmacists’ perceptions regarding pharmacist-prescribed hormonal contraceptives and their professional responsibility

BackgroundCurrently, 13 U.S. jurisdictions allow for pharmacist-prescribed contraception; however, pharmacists’ intention to use and ultimate uptake of this patient care opportunity have been variable. ObjectivesThe objectives of this study were to (1) identify student pharmacists’ attitudes toward pharmacist-prescribed hormonal contraception (HC), (2) identify student pharmacist perceived barriers regarding pharmacist-prescribed HC, and (3) explore what factors affect student pharmacists’ viewpoints. MethodsAn anonymous survey was administered using Qualtrics among third-year student pharmacists in a public health course. The survey was developed using the Theory of Planned Behavior (TPB) and previously published literature. TPB was developed to predict an individuals’ intention to engage in a behavior at a specific time and place. All responses were anonymous. Survey responses were summarized using descriptive statistics, and Wilcoxon Mann-Whitney test was used to compare differences based on student pharmacist gender and religion. ResultsA total of 67 student pharmacists participated in the survey (response rate 80.7%). Most agreed-strongly agreed (n = 59, 88.1%) that pharmacists are capable of appropriately assessing and selecting HC therapies and believe it should be within a pharmacist’s scope of practice (n = 53, 79.1%). Similarly, most agreed-strongly agreed that it is a professional responsibility for pharmacists to provide this service (n = 56, 83.6%). Potential barriers identified included limited access to patient medical records (n = 55, 82.1%), interruption to workflow (n = 51, 76.1%), and concerns for a decrease in well-women examinations (n = 51, 76.1%). Most identified with the Christian faith (n = 45, 67.2%) but said this did not influence their opinions (n = 40, 59.7%). Gender, age, and religion were not found to be associated with student pharmacists’ attitudes. However, an increasing number of barriers were negatively associated with their attitudes. ConclusionStudent pharmacists believe it is within a pharmacist’s scope of practice and a professional responsibly to prescribe HC. Student pharmacists were less supportive of pharmacist-prescribed HC if they reported a greater number of barriers.

Role of Pharmacists in Hormonal Contraceptive Access: A Survey of North Carolina Pharmacists.

The role of pharmacy in healthcare continues to evolve as pharmacists gain increased clinical responsibilities in the United States, such as the opportunity to prescribe hormonal contraception. Currently, North Carolina (NC) pharmacists do not have this ability. While previous research focused on the perceptions of community pharmacists surrounding this practice, no previous research surveyed all pharmacists in a state. This cross-sectional, web-based survey was distributed to all actively licensed pharmacists residing in the state of NC in November 2018. The primary objective was to determine the likelihood of NC community pharmacists to prescribe hormonal contraception. Secondary outcomes included: evaluation of all respondent support and perceptions of this practice as advocacy occurs on the state organization level and unified support is critical; opinions regarding over-the-counter (OTC) status of contraception; and potential barriers to prescribing. Overall, 83% of community pharmacists were likely to prescribe hormonal contraception. No differences in likelihood to prescribe were detected between geographic settings. Community pharmacists reported that the most common barriers to impact prescribing were added responsibility and liability (69.8%) and time constraints (67.2%). Fewer than 10% of respondents felt that hormonal contraception should be classified as OTC (7.9%). Noncommunity pharmacists were significantly more likely to agree that prescribing hormonal contraception allows pharmacists to practice at a higher level, that increased access to hormonal contraception is an important public health issue, and that rural areas would benefit from pharmacist-prescribed hormonal contraception. Overall, this study found a willingness to prescribe and support from the majority of both community and noncommunity pharmacists. Limitations of the study included a low response rate and potential nonresponse bias. Future research is needed to address solutions to potential barriers and uptake of this practice, if implemented.

Pharmacist prescription and access to hormonal contraception for Medicaid-insured women in Oregon

ObjectiveTo assess the impact of Oregon's policy that allows pharmacist prescription of the pill and patch on contraceptive receipt for Medicaid-insured women. Study designWe conducted a difference-in-differences analysis using Oregon Medicaid claims data to compare changes in receipt of all contraceptive services and receipt of the pill or patch for Medicaid-enrolled women (n = 436,258) before and after policy implementation in areas with and without participating pharmacists. We then described filled prescriptions for the contraceptive pill and patch by type of prescribing provider before and after implementation of the policy. We also compared past contraceptive use for women receiving prescriptions from pharmacists and non-pharmacists. ResultsWe found no significant policy effects on receipt of all contraceptive services or on receipt of the pill or patch. More than 98% of prescriptions filled for the pill and patch in the first two years of policy implementation were prescribed by a non-pharmacist provider. Women receiving contraceptive pill and patch prescriptions from pharmacists and non-pharmacists were equally likely to be continuing contraceptive users. ConclusionWe identified no increase in receipt of contraceptive services among Medicaid-insured women in the two years following the implementation of a pharmacy access policy. Additional research is needed to investigate other possible benefits of the policy, such as satisfaction, convenience, cost and equity. ImplicationsWe identified no effect of allowing pharmacist prescription of the contraceptive pill and patch on increasing utilization of contraceptive services for Medicaid-insured women in Oregon. Impacts on access to contraceptive services and unintended pregnancy may emerge in subsequent years as availability of and demand for pharmacist-prescribed hormonal contraception increases.

Pharmacist-prescribed hormonal contraception: A review of the current landscape

ObjectiveThe objective of this article is to review the current supply-side, demand-side, and regulatory landscape of pharmacist-prescribed hormonal contraception (HC) in the United States. SummaryPharmacists appear to be supportive of pharmacist-prescribed HC. However, support does not necessarily indicate likelihood to implement the practice, even when reimbursement mechanisms exist. The likelihood of implementation can be increased with education and training of HC prescribing. Previous investigations suggest that women broadly support accessing contraception within a pharmacy. Expanded access, where available, can improve rates of use and adherence. Women at higher risk for unintended pregnancy, such as younger women and women without health insurance, are likely to use the pharmacy to procure HC. Despite a willingness to pay for HC consultations with pharmacists, costs can remain a significant barrier for many women. ConclusionsExpanding access to HC through pharmacist-prescriptive authority could help curb the rates of unintended pregnancy in the United States. Pharmacists are well positioned for such a role; however, significant barriers for pharmacists and patients remain. Examination of current implementation methods will assist policy makers in overcoming these barriers.

Facilitators and barriers to implementing pharmacist-prescribed hormonal contraception in California independent pharmacies

ABSTRACTIn 2013, California passed legislation to expand the scope of pharmacist practice, including authorizing pharmacists to prescribe hormonal contraception. Pharmacist-prescribed contraception was largely unavailable across the state in 2017. This study aimed to identify barriers and facilitators to offering this service in California independent pharmacies. To do so, we thematically analyzed qualitative data from structured interviews with 36 pharmacists working in independent pharmacies in 2016–17. We found that pharmacists anticipated general benefits from expanding their roles to prescribe contraception, including increasing health care access and decreasing costs. In contrast, described barriers were concrete, including lack of financial incentives and business risks for independent pharmacies. Specific barriers to prescribing hormonal contraception included time required to screen and counsel women about contraception and concerns that pharmacist-prescribed contraception would increase liability and lead to patients seeking health care less frequently. This study suggests that incentives and barriers identified by the respondents are likely to have varied and unequal impacts, with immediate barriers being potentially prohibitive for pharmacists to prescribe contraception. For independent pharmacies, perceived business risks and lack of insurance reimbursement may outweigh professional support for prescribing contraception, limiting the public health impact of legislation that should increase contraceptive access.

Time and motion study of pharmacist prescribing of oral hormonal contraceptives in Oregon community pharmacies

ObjectivesThe aim of this time and motion study was to evaluate the procedural time and steps of performing an oral hormonal contraceptive pharmacist prescribing service in an Oregon community pharmacy. MethodsA standardized patient seeking oral hormonal contraception visited 13 community pharmacies throughout February 2018 in the tri-county Portland, Oregon, metropolitan area for pharmacist-prescribed hormonal contraception services for a total of 26 patient encounters. An observer was present at each encounter to record the time for each step and the total encounter time. Each pharmacist was asked to perform assessment procedures and prescribing for each of 2 standardized patient presentations: in cohort 1 (n = 13), the pharmacist’s assessment resulted in a hormonal contraception prescription written; in cohort 2 (n = 13), pharmacist’s assessment detected contraindications and resulted in a medical referral to another health care prescriber. ResultsThe average total patient time from arrival at the pharmacy to the generation of either a written prescription for hormonal contraception or referral to another health care provider was 17.9 and 14.1 minutes, respectively. Without accounting for documentation or dispensing the prescription, the average total pharmacist time to perform the service and issue a prescription, or refer the patient, was 7.8 and 5.4 minutes, respectively. ConclusionThe results indicate that the pharmacist prescribing service for oral hormonal contraception requires a modest amount of pharmacist time. Incorporation of practice into regular workflow appears to have an impact similar to other clinical services, such as immunizations and point-of-care testing. The patient time spent with the pharmacist was similar to other health care provider visits.

Characterizing pharmacist-prescribed hormonal contraception services and users in California and Oregon pharmacies

ObjectivesThis study describes hormonal contraception services provided by pharmacists and characterizes patient populations utilizing the service at one supermarket-based pharmacy chain in California and Oregon. Study designThis is a descriptive study of 391 pharmacies in California and Oregon within a supermarket-based pharmacy chain providing hormonal contraception services and the patients who utilized those services in a 6.5-month period between August 2016 and February 2017. Data were extracted from pharmacy prescription records and available visit documentation forms to describe services provided and patient characteristics. ResultsDuring the study period, 381 trained pharmacists from the pharmacy chain provided hormonal contraception services in 391 pharmacy locations in Oregon and California. A total of 2117 visits were completed and 1970 hormonal contraception prescriptions were issued and dispensed during the study period. Researchers were able to access documentation for 676 visits (32%). Patients from various age groups (range 13–55 years old) and geographical locations (22 states total) utilized the service. Most had health insurance (74%), had seen a primary care provider in the past year (89%) and were previous hormonal contraception users (91%). Contraceptive methods prescribed include pill (n=1886, 95.7%), patch (n=31, 1.6%), vaginal ring (n=51, 2.6%) and injectable (n=2, 0.1%). ConclusionFollowing scope of practice expansion, pharmacists in a community-based pharmacy setting are serving as an access point for women to obtain hormonal contraception services and supplies. ImplicationsThis study provides an initial look at California's and Oregon's expansion of hormonal contraception prescribing authority to pharmacists. The service was available across all pharmacy locations of a supermarket-based chain in California and select locations in Oregon and utilized by diverse populations of patients. Pharmacists effectively provided hormonal contraception services and supplies to most patients seeking hormonal contraception.

Public perception of pharmacist-prescribed self-administered non-emergency hormonal contraception: An analysis of online social discourse.

Increasing access to hormonal contraception reduces unintended pregnancies. One strategy gaining momentum is allowing patients to access hormonal contraception directly from pharmacists. Commentary on online news articles provides a naturalistic and real-time data source to assess public perceptions on timely and often controversial issues. Characterize public perceptions of pharmacist-prescribed self-administered non-emergency hormonal contraception using comments posted in response to online news articles. Retrospective, cross-sectional, mixed methods analysis of public comments posted in response to articles published by major media outlets between January 1 to December 31, 2015 on pharmacist-prescribed hormonal contraception. Comments were then extracted and reviewed through a two-step process to identify emerging themes using a thematic analysis. A total of 1060 public online comments were collected from eight articles. Of these, 757 comments (71.4%) were not related to pharmacist-prescribed hormonal contraception. Thematic analysis of the 303 relevant comments (28.6%) identified three overarching messages. First, a wide variety of reasons for how pharmacist-prescribed hormonal contraception improves healthcare and/or supports patient preferences were cited, but there was no consensus on the primary vantage. Second, individuals have varying opinions about the role of the pharmacist which creates both opportunities and challenges for pharmacist-prescribed hormonal contraception. Third, practical and logistical considerations will need to be addressed by healthcare systems, pharmacies, and payers prior to and alongside implementation. Commenters were generally positive and cited several benefits, such as increasing access to healthcare, reducing unintended pregnancies, and supporting individual autonomy. However, it was acknowledged that these benefits would need to be balanced with potential safety concerns and logistical issues associated with delivering clinical services in a community pharmacy setting. Study results can help understand public concerns and may be useful in addressing barriers hindering public acceptance of expanded pharmacist roles.