Pharmacists' Role in Reproductive Health Care: ASHP Responds to Recent HHS Guidance

In July, the US Department of Health and Human Services (HHS) issued guidance to retail pharmacies across the country regarding reproductive health care services. The guidance reminded pharmacists of federal laws intended to ensure patients are not discriminated against when receiving medication or care for their reproductive health.

The American Society of Health-System Pharmacists (ASHP) responded with a letter detailing concerns about how lack of clarity in the guidance could put federal and state requirements at odds, impact pharmacists’ ability to practice, and jeopardize patient care.

In this interview with Pharmacy Learning Network, Dr Anna Legreid Dopp discusses ASHP’s concerns, as well as how increased collaboration between HHS and clinicians can benefit both providers and patients.

Can you review ASHP’s recent letter to President Biden, including the concerns and recommendations to address them?

Our letter was in response to guidance issued on Wednesday, July 13, 2022, from the Biden administration to over 60,000 community pharmacies in the United States. The guidance reminded them of their obligation under federal civil rights laws to ensure patient access to comprehensive reproductive medication and health care services.

As we analyzed that letter, we understood why the administration was looking to exert influence where it can after the Supreme Court issued its ruling in the Dobbs v Jackson Women's Health Organization case. The administration is trying to protect patient access to reproductive health care services and medications, specifically those used to treat conditions unrelated to the termination of pregnancy but that could pose legal confusion in states with abortion bans.

Every June, our members gather in our House of Delegates. This past June, our delegates and members worked to advance, through our board of directors, a new policy, which reaffirms our support for providing safe and comprehensive reproductive health care for all patients, including the use of medication therapy.

We firmly agree that no health care worker should ever discriminate on the basis of sex or disability. However, our members need some clarification on the scope and the application of this guidance, which comes at a time of great uncertainty over the legal landscape within the states after this Supreme Court decision.

There are clinical scenarios where it might be appropriate for the pharmacist to delay dispensing a medication due to concerns for the patient's safety. The patient might have a comorbid condition that needs to be further considered, or a medication could result in a drug-drug or drug-disease interaction, prompting the need for clarification with that patient and prescriber.

Pharmacists may face legal ramifications from the federal level if they do not dispense a certain medication, while also facing legal ramifications in their state for dispensing that same medication. This uncertainty creates the potential for patient harm and clinician legal liability, which altogether undermines the patient-provider relationship.

What we are trying to get a better understanding of is to what extent a clinician will be held accountable. When they are trying to use their clinical decision making and evidence-based medicine to provide the best patient care possible, how will a clinician’s health care institution or license within their state be impacted?

What do you think would be the impact of increased collaboration between HHS and ASHP?

We know the best policy is informed and shaped by those whom it impacts, and in health policy, the best policy has been developed with patient safety in mind. Without bringing clinicians to the table with these decisions, policies are not being developed with the expert and patient perspectives our members can provide.

We are concerned there is a patient safety risk with the decisions made this summer related to reproductive health policy. At the same time, we are concerned with anything that prevents pharmacists from making professional judgments about medication appropriateness, triaging appropriate care for a patient, and providing needed counseling. That is why we are requesting to have more communication with HHS as they advance this guidance and these decisions.

Thank you. With pharmacy practice changing quite a bit in recent years, how do you anticipate the role of pharmacists will continue to change as we move forward?

Leveraging the role of pharmacists in their communities and within their health care organizations is in the best interest of patients, period.

The guidance from the Biden administration states pharmacists are in a unique role to ensure patient access to comprehensive reproductive health services. We appreciated that recognition. Overall, we have seen increased appreciation of the unique value that pharmacists provide in meeting patients where they are and providing services that are critical to patient and public health.

That being said, a lot more needs to be done to fully optimize the role of the pharmacist, like legislation that supports using their medication expertise and reimbursement policies that sustain their practice.

Is there anything else you want to add?

One big additional thing. These decisions are coming at a time where we are experiencing alarming rates of attrition from the health care profession. This is a critical component of the resiliency of our health care system. We must have a healthy and thriving workforce.

A well-documented risk factor for occupational burnout in health care is when the clinician faces too many barriers to provide care for the patient in front of them. The other well known risk factor is lack of autonomy. When clinicians do not have the autonomy to provide evidence-based care using the expertise they have, it is a risk for occupational burnout.

We are very concerned with trends where policymakers at the state and federal level are trying to legislate and regulate the use of certain medications, which removes pharmacists’ professional autonomy and restricts their expertise.

About Dr Dopp

Anna Legreid Dopp, PharmD, is the senior director of clinical guidelines and quality improvement at the American Society of Health-System Pharmacists. ASHP is the collective voice of pharmacists who serve as patient care providers in health systems, ambulatory clinics, and other settings that span the entire spectrum of medication use.