Illinois governor passes "rule" on BCP dispensing

[indoflip]

Illinois governor today passed an emergency "rule" that Illinois pharmacies MUST fill BC WITHOUT delay. All this just because of the recent stories of pharmacists refusing to fill BCP on "moral" grounds. Governor Blagojevich, give me a break What do you all think about this?


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Posted on Fri, Apr. 01, 2005


Blagojevich: Pharmacies must fill birth control orders quickly

MAURA KELLY LANNAN

Associated Press


CHICAGO - Gov. Rod Blagojevich filed an emergency rule Friday requiring pharmacies that sell contraceptives to fill prescriptions for birth control quickly, following recent incidents in which a Chicago pharmacist refused to fill orders for contraceptives because of moral opposition.

"Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy or the pharmacist is not allowed to discriminate or to choose who he sells it to or who he doesn't sell it to," Blagojevich said. "The pharmacy will be expected to accept that prescription and fill it ... No delays. No hassles. No lectures."

Fernando Grillo, head of the Illinois Department of Financial and Professional Regulation, said the emergency rule clarifies an existing requirement.

"This rule is in response, a very affirmative and strong response, that we will not tolerate pharmacies and drug stores in the state of Illinois not meeting their obligation to the women of this state in providing them good health care," Grillo said.

His department also filed a formal complaint against an Osco pharmacy in Chicago's South Loop where a pharmacist did not fill orders for contraceptives. The pharmacy was cited for "failing to provide appropriate pharmaceutical care to a patient," Blagojevich said.

An Osco spokeswoman did not immediately return a call for comment Friday.

The formal complaint against the pharmacy starts the disciplinary process, which includes a hearing. Penalties could include a fine, reprimand or revocation of a pharmacy's license.

Blagojevich's emergency rule requiring birth control prescriptions be filled without delay at pharmacies that sell contraceptives takes effect immediately, spokeswoman Abby Ottenhoff said. It will remain in effect for 150 days, and the administration will seek to replace it by a permanent rule.

Under the emergency rule, if the contraceptive is not in stock, the pharmacy must order it or transfer the prescription to another local pharmacy of the patient's choice, Blagojevich said. If the pharmacist does not fill the prescription because of a moral objection, another pharmacist needs to be available to fill it without delay.

Planned Parenthood/Chicago Area CEO Steve Trombley praised the state's efforts Friday.

"When medical professionals write prescriptions for their patients, they are acting in their patients' best interests," Trombley said. "A pharmacist's personal views cannot intrude on the relationship between a woman and her doctor."

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[DownonthePharm]

This whole moral objection thing is a bit confusing. It is objected to because they are preventing conception, or because they are sexually related items? Are their other items besides BCP/morning after pill that pharmacists have refused to handle?

 

[rxqueen]

I'm glad Mr. Blagojevich is taking a stand in the name of reason against the fanatical religious right that is taking over our country. I don't believe that a pharmacist's personal morals/religion should dictate whether or not they dispense a certain drug.

I say: Go Rod, it's your birthday, it's not a holiday. Whoa-oh!

 

[jmhousem]

Why did the pharmacist refuse to fill the prescriptions? Was it a religious objection to contraception (e.g., was the pharmacist Catholic?)? Was there something about these particular patients that the pharmacist found objectionable? (That is, would the pharmacist fill BCP prescriptions for some patients, but not for others, or was this an all-encompassing policy on his part?)

 

[indoflip]

Why did the pharmacist refuse to fill the prescriptions? Was it a religious objection to contraception (e.g., was the pharmacist Catholic?)? Was there something about these particular patients that the pharmacist found objectionable? (That is, would the pharmacist fill BCP prescriptions for some patients, but not for others, or was this an all-encompassing policy on his part?)

The pharmacists we've been hearing about lately have refused to dispense BCP because they believe it is a form of abortion. In some cases the pharmacist would not only refuse to find an alternative RPh to fill it, but also confiscate the script, which is SO wrong.

I can't stand how the governor is so worried about passing legislation to prevent the sale of mature video games to minors and making sure the fill of BCP is expedited when we have a freakin' budget to balance.

 

[ultracet]

it pisses me off that he is legislating it

i hate illinois

 

[Swenis]

I'm all for it. I don't think a pharmacist's personal beliefs have any right to interfere within a professional atmosphere.

 

[MoosePilot]

All it takes is someone to violate and then challenge on the grounds that it violates their religious freedoms.

 

[Caverject]

And you're moving there! BWAHAHA!

 

[imperial frog]

Yeah, but you're a troll.

 

[WVUPharm2007]

You fools!

Look, I'm an atheist and I hate it when I hear about pharmacists using dogma rather than evidence-based medicine to make decisions, but I don't think you've realized what this does. It takes away our autonomy. It makes us nothing more than the lapdogs of physicians. It just reinforces the idea that all we do is read a piece of paper, transfer tablets in bottle "A" to bottle "B", and that's that. It specifically makes us NOT healthcare professionals. Would we dare make legislation that forces a physician to give a prescription for birth control to a woman? Of course not.

 

[Swenis]

You fools!

Look, I'm an atheist and I hate it when I hear about pharmacists using dogma rather than evidence-based medicine to make decisions, but I don't think you've realized what this does. It takes away our autonomy. It makes us nothing more than the lapdogs of physicians. It just reinforces the idea that all we do is read a piece of paper, transfer tablets in bottle "A" to bottle "B", and that's that. It specifically makes us NOT healthcare professionals. Would we dare make legislation that forces a physician to give a prescription for birth control to a woman? Of course not.

Wow, that is a very interesting take on the situation. Thanks.

 

[baggywrinkle]

"Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy or the pharmacist is not allowed to discriminate or to choose who he sells it to or who he doesn't sell it to," Blagojevich said. "The pharmacy will be expected to accept that prescription and fill it ... No delays. No hassles. No lectures."

"When medical professionals write prescriptions for their patients, they are acting in their patients' best interests," Trombley said. "A pharmacist's personal views cannot intrude on the relationship between a woman and her doctor."

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This is a very dangerous precedent.

You cannot limit this ruling to birth control or Plan B. Allow me to demonstrate

Our regulation says that if a woman goes to a pharmacy with a prescription , the pharmacy or the pharmacist is not allowed to discriminate or to choose who he sells it to or who he doesn't sell it to," Blagojevich said. "The pharmacy will be expected to accept that prescription and fill it ... No delays. No hassles. No lectures

If the patient presents with a prescription for strychnine on a stick and you
refuse to fill it you will be in violation of this ruling if the physician decides to
pursue it, or the patient decides to pursue it.

Kiss your professional judgement goodbye. In Illinois you are now a dispensing machine.

 

[ultracet]

And you're moving there! BWAHAHA!

eff off troll......

looks like i'll be fired/jailed because of my first job.......

 

[Sosumi]

It doesn't take away that much autonomy. It's justified for only emergency contraception since there is a time concern.

Part of being a professional is making decisions in which you think are best for your patient even if it does not meet your moral grounds. Doctors and nurses must do this everyday when treating their patients. Why shouldn't pharmacists who wish to be seen as healthcare professionals not be held to the same standards?

 

[ultracet]

It doesn't take away that much autonomy. It's justified for only emergency contraception since there is a time concern.

Part of being a professional is making decisions in which you think are best for your patient even if it does not meet your moral grounds. Doctors and nurses must do this everyday when treating their patients. Why shouldn't pharmacists who wish to be seen as healthcare professionals not be held to the same standards?

the interesting thing is... with that law we have no say in what is best for the patient's health

for instance a 40 YO 2ppd smoker comes in with an rx for BC

i say....
you need to stop smoking would you like some information? they say no.. give me my BC

now... my professional judgement says no.
but the law says i have to.

what do you do?

 

[Sosumi]

the interesting thing is... with that law we have no say in what is best for the patient's health

for instance a 40 YO 2ppd smoker comes in with an rx for BC

i say....
you need to stop smoking would you like some information? they say no.. give me my BC

now... my professional judgement says no.
but the law says i have to.

what do you do?

It depends on how the law is stated. I don't know what it literally says, but from my interpretation of the article, it seems more toward keeping pharmacists from being protected from withholding medication merely on personal religious and moral reasons without regard to the patient's health and well being. The article does use those buzzwords like pharmaceutical care. Also, the pharmacist can choose not to fill it on moral reasons, just has to allow the woman the opportunity to have another pharmacist who's willing to do it.

As such in your instance, I would explain that I would need to talk with her physician first before the prescription could be filled. As a community pharmacist, you're often not at liberty nor unfortunately have developed a rapport with your customer/patients as her primary care provider so it's difficult to get the whole picture and therefore should not be determining treatment options.

I do agree that the law seems like overkill and really just political grandstanding. Almost all chains already have a policy like that in effect as far as I know.

 

[njac]

I am so glad to see this.

I am not yet in pharmacy school, but I am in the application process. But to me, unless there is a potential drug interaction, the prescribed medication is between the doctor and the patient. Be it something I agree with (emergency contraception) or don't agree with (fertility drugs), that decision was made between the patient and the doctor and they don't need my opinion to get in the way.

 

[Caverject]

Yeah, but you're a troll.

But you don't even know me!

 

[imperial frog]

But you don't even know me!

I've got it on good authority from other people. Quit denying it.

 

[Caverject]

Did I meet you today or something with your chapter members at caucus? LOL

 

[ultracet]

where in the world is Illinois pharmacy association issue on this one?!?!?!?!?

 

[nikkai]

Yikes, and UIC is one of my top choices for schools too.

This whole thing is why I'm going clinical/abulatory care/clinic route.

 

[indoflip]

where in the world is Illinois pharmacy association issue on this one?!?!?!?!?

If anyone is interesting in reading the response the Illinois Pharmacy Association/APhA/ASHP sent to the governor on this topic PM me your e-mail and I will forward it to you. It was emailed to me because I'm an IPhA member but unfortunately its a PDF file so I can't cut/copy/paste it its interesting though.

 

[Caverject]

April 5, 2005
The Honorable Rod R. Blagojevich
Governor, State of Illinois
Office of the Governor
207 State House
Springfield, IL 62706


Governor Blagojevich:
The undersigned organizations, representing pharmacists in Illinois and across the country, respectfully request rescission of
the emergency rule issued April 1, 2005, requiring pharmacies to provide contraceptives based on a valid, lawful prescription
without delay. The order, as worded, poses substantial risk to patient care and creates a substantial challenge for pharmacists
licensed to practice in Illinois.

We support the premise of the Governor’s order to ensure women have access to health care. It is unfortunate, however, that
your office failed to work with the profession to address these concerns. The order, as issued, is flawed. Specifically, the
order creates a professional dilemma for pharmacists: the requirement to dispense a valid, lawful prescription ‘without delay’
could require a pharmacist to dispense a valid, lawful—but clinically inappropriate—medication ‘without delay’. This
requirement conflicts with the responsibilities outlined in the Illinois Practice Act, specifically requiring pharmacists to
conduct prospective drug utilization review.

Such a review could identify, in a valid, lawful prescription, a clinical problem that requires the pharmacist to work with the
medication prescriber to resolve the situation. For example, a woman may be prescribed an oral contraceptive by one
physician but may also be receiving treatment from an internist or cardiologist for a deep vein thrombosis condition. The
pharmacist would recognize therapy to treat the condition (such as warfarin) on the profile and identify the potential problem.
Contacting the appropriate prescribers would not allow the pharmacist to dispense the product "without delay". But failure to
contact the involved prescribers would require the pharmacist to ignore their role in conducting prospective drug utilization
review. While we expect pharmacists to resolve this question in favor of the patient, they do so at the risk of sanction under
the emergency order. The potential for harm is much higher for receiving the oral contraceptive in this situation than waiting
the time it might take to discuss this with the prescribers.

Unfortunately, your spokesperson’s comment to the media that the order would not interfere with our profession’s role in
‘patient counseling’ is neither helpful nor relevant. The conflict is not with the pharmacist’s role in helping patient’s
understand their therapy, but with the prospective review for the clinical appropriateness of the therapy. Our concern with
this requirement is not limited to pharmacists. Careful review of the statement from the American Medical Women’s
Association supporting the order notes that their support for the pharmacist continuing in their role of identifying
contraindications.2 Unfortunately, the emergency order is inconsistent with the pharmacist maintaining this role.

Further, the order requires pharmacists and pharmacy operators to comply with one specific set of beliefs. Our profession is
composed of individuals, not automatons. Prohibiting pharmacists from stepping away from certain activity because of their personal moral beliefs requires each pharmacist practicing in Illinois to abide by one set of beliefs. Not only is this approach
inconsistent with the idea that individuals should have a choice in the activities in which they participate, it is a recipe for
disaster. It is possible to assure patient access to legally prescribed therapy as well as accommodate individual pharmacist’s
beliefs, but we must work together to do so.

There are important alternatives to the flawed approach announced last week. A far more proactive approach to expanding
access to contraceptive therapy for women in Illinois would be to clarify that pharmacists are authorized under state law to
expand their role under collaborative drug therapy management agreements. In this structure, pharmacists would work with
physicians to establish the parameters where pharmacists both initiate and dispense contraceptive therapy for certain
patients—thus expanding access by narrowing the situations where a woman must see a physician to access emergency
contraception or other appropriate interventions. Illinois could join the growing list of states where pharmacists provide such
services3—expanding patient access while simultaneously navigating the conscience issue because women are directed to
those facilities where pharmacists expand access to therapy.

Another approach would establish a public registry where pharmacies that carry and dispense all contraceptive therapy are
listed. The limited number of pharmacies where access may not be available would not register, and thus women would be
proactively directed to alternative sources.

Again, we emphasize that we support the premise of the Governor’s order to ensure women have access to health care, but
the solution is fatally flawed. By compromising the pharmacist’s ability to exercise their clinical judgment, the order puts
women’s health at risk. We strongly encourage you to reconsider this action and work with the profession to address these
concerns. All patients must have access to appropriate medications. And no patient need be aware of a pharmacist’s
individual moral code. But no pharmacist should be forced to ignore their professional, clinical judgment. The emergency
order implies that contraceptive medications and the women who take them do not deserve the same care from the pharmacist
and the recognition for potential harm afforded to all other prescription medications.

Thank you for your consideration of our request. We look forward to initiating a dialogue to address this important issue.

Sincerely,
Michael Patton
Executive Director
Illinois Pharmacists Association

John A. Gans, Pharm.D.
Executive Vice President
American Pharmacists Association

Henri R. Manasse, Jr., Ph.D., Sc.D.
Executive Vice President and Chief Operating Officer
American Society of Health-System Pharmacists

 

[baggywrinkle]

NACDS SmartBrief April 14, 2005 E-Mail news for the retail pharmacy industry




Pharmacy News





Pharmacists sue over birth control rule
Two pharmacists in Illinois who refuse to fill prescriptions for emergency contraceptive measures based on their religious beliefs are suing the state's governor over a rule he issued on April 1. The rule requires pharmacies to accommodate patients with either another pharmacist or to transfer the prescription to another local provider. The litigants charge that the ruling two weeks ago violates another state law that allows individuals to participate in health care according to their conscience. Chicago Sun-Times (4/14)

Wisconsin pharmacist also in contraceptive fray: The Wisconsin Pharmacy Examining Board has ruled against a pharmacist who refused to fill a contraceptive prescription in 2002 over religious objections. Milwaukee Journal Sentinel (4/14)

 

[meg]

As a person who takes birth control, I think I would go on a tirade if a pharmacist took my prescription, wouldn't fill it, and wouldn't give it back. I'd definitely complain to the management. I understand if you don't want to fill it, but at least give it back to me so I can find someone who will.

 

[CSzGirl]

I can't wait until the first woman who has an unwanted pregnancy because a pharmacist refused to fill a BC or Plan B prescription sues the pharmacist for child support.

 

[Roxicet]

This is a very dangerous precedent.

You cannot limit this ruling to birth control or Plan B. Allow me to demonstrate

Our regulation says that if a woman goes to a pharmacy with a prescription , the pharmacy or the pharmacist is not allowed to discriminate or to choose who he sells it to or who he doesn't sell it to," Blagojevich said. "The pharmacy will be expected to accept that prescription and fill it ... No delays. No hassles. No lectures

If the patient presents with a prescription for strychnine on a stick and you
refuse to fill it you will be in violation of this ruling if the physician decides to
pursue it, or the patient decides to pursue it.

Kiss your professional judgement goodbye. In Illinois you are now a dispensing machine.

Hey baggy, but "strychnine on a stick" isn't legal, so is this really a comparable situation? I don't agree with assisted suicide, but if it were legal, I would fill it with a smile, or if I really didn't want to dispense it, I would take a paycut and find a niche in pharmacy where I would never have to fill such scripts. I'll stand by my belief that those "christian" pharmacists in retail are a bunch of hypocrites because if they felt so strongly about their beliefs, they could take a paycut too. Last time I checked, greed was a sin too.

 

[baggywrinkle]

Hey baggy, but "strychnine on a stick" isn't legal, so is this really a comparable situation? I don't agree with assisted suicide, but if it were legal, I would fill it with a smile, or if I really didn't want to dispense it, I would take a paycut and find a niche in pharmacy where I would never have to fill such scripts. I'll stand by my belief that those "christian" pharmacists in retail are a bunch of hypocrites because if they felt so strongly about their beliefs, they could take a paycut too. Last time I checked, greed was a sin too.

Remove strychnine on a stick and substitute anything that requires professional judgement. If I may quote;

"expected to accept that prescription and fill it ... No delays. No hassles. No lectures"

So when I saw a pediatric prescription last spring for clonidine 0.1mg po HS
I called to clarify it with the office. The nurse slapped me down with a curt that's what he wrote that's what he wants. I dug in my heals and copped an attitude - never mind this was a refill which had been filled 2-3 times already. The pharmacy technician did not see a problem. When I forced the office to review the prescription they quietly changed it to klonopin 1mg po hs and never acknowledged their error to me. The family did thank me later. Under the terms of this new mandate I would have been in violation.

I could care less about the motivation behind refusing to dispense.

Professional judgement, that is what it is all about. If you exercise poor judgement than you shall reap the harvest

 

[WVURxGal]

Looks like Washington is getting in on the fun.

http://www.cnn.com/2005/POLITICS/04/14/prescription.bill/index.html

 

[NYCillini]

Great topic!

As pharmacists we are still required to educate the patient on the med (i.e. tell pt that smoking increases risk of cancer). However when the law is saying "no lectures" it means don't give the patient a religious sermon and tell them by taking the med they are going to hell.

Has anyone noticed that pharmacists are dropping in the rank from the most trusted profession? Too many people are rushing to judgement without knowing the whole picture.

As far as regular BC goes I know plenty of virginal or unsexually active women who take it. Some take to prevent pregnancy in the event of rape/or potential rape (some live/work in dangerous neighborhoods). To help clear up skin (there's a lot hassle involved with women taking accutane). To help with PMS or for some the body's inability to hold the uterine lining leading to excessive or daily bleeding (problematic since some women experience fainting spells, sleep for over 14 hrs a day, or even need blood transfusions). Overall, I strongly believe that BC helps women lives more normal lives and based on merely looking a prescription you wont know the whole picture

 

[Roxicet]

Remove strychnine on a stick and substitute anything that requires professional judgement. If I may quote;

"expected to accept that prescription and fill it ... No delays. No hassles. No lectures"

So when I saw a pediatric prescription last spring for clonidine 0.1mg po HS
I called to clarify it with the office. The nurse slapped me down with a curt that's what he wrote that's what he wants. I dug in my heals and copped an attitude - never mind this was a refill which had been filled 2-3 times already. The pharmacy technician did not see a problem. When I forced the office to review the prescription they quietly changed it to klonopin 1mg po hs and never acknowledged their error to me. The family did thank me later. Under the terms of this new mandate I would have been in violation.

I could care less about the motivation behind refusing to dispense.

Professional judgement, that is what it is all about. If you exercise poor judgement than you shall reap the harvest

I still believe that moral judgement and professional judgement are mutually exclusive, and I do believe that any legislation needs to recognize that. In your case, you didn't feel that it was morally wrong to dispense the clonidine; you knew that the patient's safety would be compromised, not your morals. The excerpt you quoted above was specifically regarding BCP, and I agree with it 120%.

 

[baggywrinkle]

I still believe that moral judgement and professional judgement are mutually exclusive, and I do believe that any legislation needs to recognize that. In your case, you didn't feel that it was morally wrong to dispense the clonidine; you knew that the patient's safety would be compromised, not your morals. The excerpt you quoted above was specifically regarding BCP, and I agree with it 120%.

What will you do when your professional judgement is interpreted through a moral lens in the eyes of the law. I agree that the issue needs to be addressed. My solution is to make Plan B otc and wash our hands of the entire affair. If legislation is needed it would be APPROPRIATE
if the parties concerned were consulted to assist in drafting the language of the law. Thus far, pharmacy practice advocates have not been approached.
Be careful what you ask for. The climate you create is the practice environment you will be forced to live with for a very long time. I will be retired soon and will hand it all over to you with a sigh of relief!