Should Pharmacists Be Forced To Sell Plan B?
35 CommentsBy Ed Silverman // March 19th, 2008 // 4:58 pm
A group of pharmacists is asking the Illinois Supreme Court to throw out a rule that forces them to dispense the Plan B emergency contraception pill despite their moral objections, claiming it amounts to illegal coercion, the Associated Press reports. The pill, which is sold by Barr Labs, is generally available over the counter to women who are at least 18 years old, but by prescription to those under 18.
Illinois Governor Rod Blagojevich issued the rule in 2005, prohibiting pharmacies from turning away women seeking emergency contraception. But pharmacists who don’t want to dispense Plan B say it’s tantamount to abortion, and argue that Illinois law protects them from choosing between violating their consciences and losing their licenses, and that they shouldn’t have to wait until they’re out of jobs to seek justice.
The Illinois rule led to several lawsuits, including one in federal court that was settled by a compromise in which objecting pharmacists wouldn’t have to participate in filling the prescription. In such cases, a pharmacy employee would contact a pharmacist at another location, then follow his or her directions for dispensing the morning-after pill. The rule, though, still needs approval from the state Department of Financial and Professional Regulation.
Should pharmacists be required to sell the pill?
- Yes (70%, 100 Votes)
- No (30%, 43 Votes)
Total Voters: 143
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Since the pharmacists sued in 2005, a pharmacy owned by one plaintiff closed because no pharmacist would work there under the state’s threat of license revocation. Mark Rienzi, a lawyer for the pharmacists, said outside court that, generally, customers who are denied the pill have accepted that they had to go elsewhere for it, although they could have complained and forced state sanctions on the stores.
A lawyer for lagojevich argued that the pharmacies in the lawsuit don’t have standing to sue because they have suffered no repercussions. Laura Wunder, an assistant state attorney general, told the court those pharmacies don’t even stock so-called “morning-after” medication, so it’s unlikely they would violate the rule.
In oral arguments, however, justices bluntly pointed out to Wunder that the pharmacies must get the drug if requested - and that their licenses would be at risk if they failed to comply. Wunder countered that the pharmacies have been unable to show that they’re in jeopardy of state penalties because it’s unlikely that a customer would ask a pharmacy to order a medicine that is needed right away.
Rienzi said his clients should be able to sue even if they haven’t suffered repercussions, because they are protected by two state laws: one that prohibits forcing health care decisions over moral objections, and one insulating citizens from religious interference.
“They are designed to protect people from coercion and burden,” Rienzi said. “They are not only designed to protect people after the ax has fallen, after your license is taken away, after your career is ruined.”
He added that approval of the compromise rule would help individual pharmacists, who could opt out. But he said that the rule would require all pharmacies to stock the drug and that his clients are pharmacy owners who don’t want the drug in their stores at all.
Source: The Associated Press
James
Stunning to me that men and women of science, who holds doctorates, would claim Plan B is tantamount to abortion. Plan B is as much abortion as the standard birth control pill or the condom.
Why science-minded people would be puppets for right wing propagandists is beyond me.
Jack2
Oral contraceptives reduce ovulation and increase mucus thickness to prevent sperm from reaching the egg.
Patients who ovulate, get pregnant, and take the morning after pill block the lining of the endometrium from developing properly to accept a fertalized egg (by interacting with progesterone).
Vote the way you want on this poll, but I don’t think it’s a stretch to view the means (no ovulation vs. no development of a fertilized egg) to the same end (no babies) as something validly different.
Jack2 RPh, PhD(Pharmacology)
Chris
Thanks Jack2 for a helpful and objective summary.
Former pharma Marketing Exec
Why do pharmacists feel they have to make a moral judgment about the patients they are there to serve? What if the reason for the pill is for cases of incest or rape? Why should women be further discriminated against?
Hopefully no women will be denied the pill because no pharmacy in their town wants to stock it.
Perhaps a solution would be to make the drug available at the local hospital and avoid the problem of going to a pharmacy all together. It does seem that it would offer much more dignity.
pharma pr hack
The Plan B pill is nothing more than a more concentrated dosage of a higher estrogen than normal birth control pill.. Physicians make-shifted it for years by telling a patient to take a 6-3 combination.
While Jack 2, you may feel the mechanism of action is different- the chemistry is the same.
I agree with the former marketing exec, if you don’t want to dispense any and all medical treatments ordered by a physician than you are more than welcome to find another line of work.
There is no religious exception for designating your beliefs above a person’s healthcare. What is next, refusing to dispense AIDS treatments because you believe the person is gay, it was God’s wrath and you don’t want to interfere with their slow painful death?
Lisa Van S
Former pharma marketing,
Plan B is available in a hospital. I would encourage any victim of rape or incest to go to the emergency room,.. rape counselors are available 24 hours a day, and victims will be treated for potential STD’s. On he other hand, if a Mom & Pop pharmacy chooses not to carry it, then the Govt. shouldnt force them to.
Jack2- Thanks for the Sex Ed Class…. Did you google the good Dr.?
ol cranky
Lisa:
There are physicians, nurses and pharmacists in ERs that are the only local facility that refuse to not only dispense plan B to rape victims, they will refuse to refer them to someone else who will.
Lisa Van S
Ol Cranky,
Hospitals that have rape crisis care would never turn a victim away, or, refuse to provide treatment. Just ask any women’s crisis center.
Chris
FPME et al - what if the reason for wanting Plan B is nothing to do with incest or rape? Not sure if you have any numbers of incidence of that vs anything else, including post hoc deliberance (sic). I suspect the former is much, much less prevalent than the latter. And if the pharmacist is the last one to dispense the packet maybe he/she does feel some responsibility. After all, it’s a big deal for all concerned and not to be confused with contraception, regardless of chemistry arguments. Perhaps that touches on the previous rhetorical question.
pharma pr hack
Lisa, i respectfully disagree, if you open a shop to provide medical coverage i.e. pharmaceutical dispensing- you can no more refuse to provide plan B to a woman because of your “religious beliefs” than you can refuse to provide any pill because of to a black individual because of your prejudices. Medical care, whether it be a hospital, pharmacy or pharma company, transcends your personal religious beliefs, profit and loss and your prejudices. It has too. I personally don’t like or condone homosexuality and the religion i practice says it is amoral but that wouldn’t give me the right as a doctor or a pharmacist to change their treatment protocol or deny them treatment. If I didn’t feel able to fulfill that need, then i need to find another line of work. PERIOD. There is a separation of church and state in this country and it is specifically so that basic needs like this aren’t subjected to the whims of people’s personal religious beliefs. Just the other day the catholic church in my state opted not to support the Komen Foundation for breast cancer survivors– the pervasiveness goes beyond pharmacists.
I personally belief that the use of oral contraceptives even at such a late stage as Plan B is both a medical and personal decision. I don’t believe a person’s individual uterus has anything to do with you, me, the pharmacist or the government. To believe otherwise that it can be legislated is the flip side of China with forced abortion and sterilization. Once a uterus in the public domain, when the next party comes in power or the situation changes - the precedent has been set.
There has to be limits to what we do in the name of superimposing our need for our religious beliefs, our need for profits, etc. to an individual person’s healthcare, which truly doesn’t affect that pharmacist past that 15 minute service and affects the person who is trying to fill a prescription day in and day out for the rest of their life. When weighing it surely you must understand how much consequential it is for the patient versus the pharmacist.
Atlex
Lisa,
Your comments suggest a suburban bias. Where you (and I) live, there are many, many pharmacies and plenty of hospitals with rape crisis centers. If one pharmacy doesn’t carry or won’t sell Plan B, then there are 10 others within 15 minutes that probably do. However, this doesn’t work in rural America where the local hospital may not have a rape crisis center and there is only one pharmacy in town. That’s is where the pharmacist’s religious belief can and doesn interfere with a woman’s right to health care.
Atlex
Former pharma Marketing Exec
This is again another interesting thread - thanks all for sharing.
Lisa: Of course I do realize victims of incest and rape should be treated in the ER, but as we know that is not always possible. The point I was making is exactly what has been stated in the other posts here. The drug is approved, the law provides a way for patients to access it, religious beliefs of anyone in the healthcare system cannot be placed before the concern and needs of the patient. Otherwise you cannot serve the public, which as we note is multicultural, especially here in America.
Chris, you make a good point. I have no idea about how many times Plan B is used as a “substitute” for careful birth control. One hopes that all women who are sexually active are being seen by an Ob/gyn. In my opinion, it is not the pharmacists duty to educate the patient on proper birth control. In fact, I think this defeats the purpose of the drug being so publicly available. This being said, I would imagine that there is a booklet or product monograph given with the drug that covers what the patient needs to know and how to use it.
Pharmacists do and should continue to educate patients on what they need to know about the drugs they are taking. That is their expertise - end of story.
Lisa Van S
Pharma pr hack,
I have been,.. and always will be ProChoice. Adolescents should be educated about safe sex, It is our responsibility as adults to teach them. On the other hand,.. neither you or I, have the right to tell others how to raise their children. If abstanence is what they choose, then their decision should be respected.
If a mom & pop pharmacy chose not to sell a certain antidepressant or antipsychotic to a child under 18,.. would we be having this same conversation?
With all that said,.. It is my belief, that if a private business chooses not to sell a particular product,.. then shouldnt have to. Just my two cents…
Jack2
I agree with Lisa.
First, from a chemistry perspective it doesn’t matter that the two drugs are the same ingredient in different doses - it’s the timing of drug administration. I think it’s valid to distinguish between the two, and people who don’t see it (or don’t want to see it) that way, are trying to mislead others.
Second, I personally support a woman’s right to choose (not that it’s relevant). But I also support a pharmacist’s right to choose. When a pharmacist chooses not to fill the script, they’re not confiscating it, they’re just sending the patient to another pharmacy with the script.
And pharmacists aren’t like other healthcare professionals who give abortions or work at abortion clinics. A doctor who doesn’t agree with abortion can work in a different area. A retail pharmacist doesn’t specialize and must take all comers - they can’t easily avoid the issue. Plus, many pharmacists went to school before this drug even existed, and didn’t know they’d be put into this ethical dilemma.
I think people who want to force the pharmacist to fill the script cannot sympathize with the pharmacists position that (s)he believes filling the script will participate in a murder. Just because you don’t think it’s murder doesn’t mean someone else doesn’t see it differently. And based on HOW THE DRUG works it’s not crazy to see this as murder if you see abortion as murder.
Again, I support both a woman’s, and a pharmacist’s right to choose.
Lisa Van S
Atlas,
“Your comments suggest a sububan bias”.
I have to politely disagree. Birth Control has always been,.. and always be a personal choice, no matter where you live. Im sure one can get RU486 over the internet. Many women have located a pharmacy that sells it and keep it in the medicine chest, just in case of an emergency.
Rape and Incest Victims should reach out to a Woman’s Crisis Center or an Emergency Room where not only will the woman rcve excellent medical care, they will also have access to highly trained professionals for Emotional support.
pharma pr hack
Jack and Lisa -
I completely understand where you are coming from but i do believe strongly that in a longterm view - it is a really slippery slope to allow a healthcare provider to decide to put their personal beliefs before an individual’s healthcare - where does it stop when it starts?
You say Plan B is justifiable due to a person believing it is tantamount to “murder” but what about the other religious beliefs that aren’t quite so mainstream? That are harder to digest- the nurse who doesn’t believe in extending life by artificial means and refuses to put a person on a ventilator? the individual who doesn’t believe in homosexuality and won’t treat the AIDS victim? The person in the ER who doesn’t believe in murder and won’t give the incest victim who is 12 Plan B??? You can’t make a special set of rules for one healthcare provider without extending them to all healthcare providers and once you start for one “religion” you can’t not extend it to all.. It is a very slippery slope where you have to set personal beliefs aside and recognize that an individual’s healthcare is just that- individual.
Jack2
I also see your point pharma pr hack. But I think these slippery slopes exist anywhere an individual’s freedoms (especially religious freedom) clashes with societies.
I don’t have the magic answer about where the line is drawn, and I think it’s a personal issue. I just think I draw the line a little bit closer to individual freedom than you (and probably close to individual freedom than most people).
Anyway, I understand why people vote one way or the other. I mostly just got dragged into this because I wanted to point out that scientifically the difference in timing of when you receive the drug (and dose) leads to what some people could legitimately view as a different moral outcome.
sosonj
I would deny the pharmacist any ability to refuse to fill a legal Rx and to refuse to stock a legal Rx item. I do not think a pharmacist should interfere in the doctor-patient relationship unless the safety of the patient is endangered.
I think it is time to re-think the role of the pharmacist in the healthcare system. For most transactions, the computer print-out is more comprehensive and accurate than the pharmacist, technician or clerk in noting possible interactions and adverse reactions. Indeed, my Rx is usually filled by a slightly frenetic technician and not a pharmacist.
I wonder if retail pharmacy could be accomplished with trained employees that are not pharmacists. Even now, not all retail pharmacies will compound. The independent retail pharmacy is a dying breed. The huge retail pharmacy chains seem to use the pharmacy department as a draw so customers can be tempted by piles of stuff from China.
I understand the need for pharmacists in hospitals and in that niche of “specialty pharmacy” that compounds questionable preparations for gullible patients. But I wonder if more pharmacies would be operating without the need for an RPh in each location.
Atlex
Lisa,
Having grown up in the rural South, I can attest to the fact that access to these medicines and related services is already questionable. Small town hospitals and independent pharmacies in the bible belt often refuse to sell plan B. The Internet, while possibly an option, is not always practical.
Alex
Chris
Aside from any debate on the value of pharmacists (sosonj) I suspect that fear of liability issues would deter moves to dispense with pharmacists from retail pharmacies.
Lisa Van S
Atlex,
Ok, Ill probably start a riot here,.. But, who says an individual has to live in the Bible Belt. A Pharmacist who wont prescribe RU486 is rare,.. So if you cant find what you want at Shoprite,.. then you go to Wegmans. Its just that simple.
Lisa Van S
Atlex,
I just remembered something. I lived in Belgium for almost 5 years, and RU486 could be purchased in the Pharmacy. On Sundays the majority of shops and Pharmacies are closed, with the exception of one Pharmacy that is open for emergencies, and often you would have to travel to the neighboring town. In convenient, yes, but thats life!
Atlex
Lisa,
I say this with all due respect, you just don’t understand the rural parts of this nation. It’s not like living in the “rural” areas of NJ where you may have to travel 3 or 4 miles to the closest food and drug store, but there are 5 or 10 more within 15 or 20 minutes. In rural parts of the South, midwest and west, small towns might (or might not) have one grocery store and one drug store. The next closest might be 25 or 30 miles away (and maybe that one also decides not to sell Plan B). Remember, there are whole states where there are no (zero) abortion providers. Unfortunately, for many, simply moving out of the Bible belt is not a “snap of the fingers” proposition either.
Lisa Van S
Pharma Pr Hack’
Gee,… Why dont we tell Good Year, that “must” sell Michelin.
Why dont we tell pfizer that they “must” manufacture and sell Paxil.
Why dont we tell a Podiatrist he “must” become an OB/GYN.
Tell a Heart Sugeon he “must” perform Brain Surgery.
Sound Silly, sure it does,… and its just as silly as your last post.
Lisa Van S
Atlex,
All I can say is this,. you get what you “Vote” for. If one wants change,..Then “Vote” for change. As I have stated before, I am Pro Choice. And I believe a Pharmacist is entitled to the same freedom to choose, no matter what their personal beliefs are!
pharma pr hack
Lisa, you are unfortunately mixing a commercial enterprise with a healthcare relationship - one that when it comes to the prescribing of anti-depressants and psychotic drugs to adolescents you are pretty succinct about the need to remove marketing and other factors away from the sanctity of the doctor/patient relationship. However, when it comes to medical care that isn’t as important to you personally, your very willing to allow the pharmacist to intercede in that doctor/patient very personal relationship. The hypocrisy right there is pretty much the slippery slope all of my posts described as the worst possible case in making the exception.
I respect your right as a patient to get your care from your physician free from interference of pharma marketing companies, strong armed tactics,hiding of clinical data, etc. .. just as I respect a patient’s individual care not to be compromised by the religious beliefs of the pharmacist.
I wouldn’t tell a heart surgeon he must provide brain surgery but i sure as hell would legislate he provide heart surgery on someone he found didn’t agree with his religious beliefs and was unwilling to operate as letting them live would violate them.. At that point, he would need to have his license revoked for denying medical care.
A pharmacist’s job is to dispense medication.. PERIOD. Neither I, you or anyone else exists to pass judgment and he should not be allowed to withhold anyone’s medical care based on his religious beliefs. If his beliefs do not allow him to fulfill his duties, then he needs to look for another line of work but people’s healthcare should not be compromised for that any more than they should be compromised for my client’s or anyone’s else’s bottom line.
Lisa Van S
Pharma Pr Hack,
“You are unfortunately mixing a commercial Enterprise with Health Care”
That’s funny,…. Its just a matter of time before we start to see RU486 advertisements coming across our television screens. The advertising will follw the VIVA VIAGRA ads.
Just a quick note: Their is no safety data for those under 18. If I were a Pharmacist, who, dispenses to those under 18.Id make sure i had “GREAT” liability insurance. Its not just about Religion!
Lisa Van S
PR,.. One last thought. Can one assume that yo are an employee of the Company who manufactures RU486? May shed some light into your inability to see another’s point of view.
James
I see a lot of mentions of RU486. I think it is important to note that Plan B/The Morning After Pill is NOT RU486–the “abortion pill.”
Plan B is much more akin to standard birth control, as pharma pr hack accurately noted above.
As to the issue itself, besides my above comments on the disingenuity of claiming Plan B is tantamount to abortion, should the right of a pharmacist/business to control what it sells trump the right of an individual to access a legal pharmaceutical?
The point above of suburban bias is interesting–when someone has access to 50 different suppliers, the decision of any one or several is likely to have a limited impact. But imagine if a scientologist was the only pharmacist in town.
“Can I get a refill of Zoloft?”
“No. Here’s a multivitamin.”
“But, I want my prescription.”
“Try exercise.”
“But I have a right to what my doctor prescribed me!”
“You’re probably just dealing with issues resulting from your mother talking during your childbirth. Let’s get you clear.”
It would be almost as bad as LVS, Pharm.D!
Women should have access to their prescriptions in a timely manner. Even with the Interweb, even FedEx can’t deliver fast enough when emergency contraception is needed.
Les
I thought a prescription is defined as a lawful order by a licensed to pracetice person. Has it changed since I otained my pharmacy license?
Lisa Van S
James,
Fedex does,.. they guarantee by 10am the next day. Like ive said before every individual has the right to choose what is right for them. Many women are smart enough to keep reserves in their medicine chest. Should a Pharmacist be responsible for a woman who has chosen not to be resourceful. Since I am a woman, I do feel I am qualified to make that statement.
I heard a story a few years ago,.. a Pharmacist was prescribed Prozac for mild depresion and suffered severe akathisia and suicidal thoughts. She wasnt a Scientologist, but she did choose not to dispense Prozac to others.
Les
Lisa,
I see so many unresourceful, irresponsible men and women daily. Since I am a pharmacist, I do feel I am qualified to make that statement. If only all my customers were responsible like you.
Lisa Van S
Thanks Les..
Lisa Van S
James,
A Pharmacist, who is a scientologist, will always refill a prescription for an antidepressant. They understand, and respect the horrific side effects of abrupt withdrawal, including Homicidal/Suicidal thoughts and actions.
HMiller
Lisa VanS,
I am a Rape Crisis Counselor and in my state, if a victim of rape or incest goes to the hospital ER for treatment, the staff is required to report to the police. What if the victim only wants to be treated but not report?? Allowing doctors & after-care clinics (such as those affiliated with women’s health care centers)to prescribe only to have pharmicists pass judgment on who they dispense to or what they dispense is absurd.