Wednesday, June 2, 2004

Rules process
delays ‘morning
after’ pills

Lingle signed the bill
for nonprescription
after-sex birth control

An emergency contraception bill signed into law nearly a year ago by Gov. Linda Lingle has been delayed by rulemaking that women lawmakers say is “completely unnecessary.”

How they work

Some facts about the emergency contraceptive pills:

>> Emergency contraceptive pills contain the same hormones as birth control pills but are stronger.
>> They temporarily stop eggs from being released when used within 72 hours, preferably within 48 hours, after unprotected sex.
>> No serious adverse effects have been associated with the pills.
>> They don’t affect a woman’s ability to become pregnant in the future.
>> If taken mistakenly during pregnancy, they won’t harm the developing fetus.

Source: Pharmacy Access Partnership

“Act 201 is about giving Hawaii’s women timely access to this important treatment -- a purpose which is not served by unnecessary delays in the implementation of this law,” the Women’s Legislative Caucus said in a May 4 letter to the Department of Commerce and Consumer Affairs director and Board of Pharmacy executive officer.

Hawaii’s emergency contraception law, which allows pharmacists to dispense “morning after” pills without prescriptions, doesn’t require administrative rules, but the Board of Pharmacy is going through the process to ensure patient safety, at Lingle’s stipulation, according to the nonprofit Healthy Mothers, Healthy Babies Coalition of Hawaii.

“Unfortunately, it’s a 16-step process, now at step 3,” said Barbara Kashiwabara, Kaiser Permanente director of pharmaceutical services , who attends Pharmacy Board meetings.

Lee Ann Teshima, the Pharmacy Board’s executive officer, said proposed rules have been completed and she hopes to have the necessary administrative approvals to schedule a public hearing in July.

“We tried to cover as much as we possibly could so we hopefully could get this through without too much opposition or people trying to fight us the whole way,” she said. “As good a program as this is, it is still controversial.”

Hawaii was the third state after Washington and California to enact a law allowing women to get “morning after” pills from pharmacists without prescriptions. Alaska, New Mexico and Maine have similar laws.

“Other states with emergency contraception access implemented it immediately,” said Nancy Partika, Healthy Mothers, Healthy Babies executive director. She and Kashiwabara were among state and Canadian representatives at a meeting of the Pharmacy Access Partnership recently in San Francisco.

“People were very impressed with what Hawaii has done but rather mystified as to why we haven’t managed to implement such a needed program,” Partika said.

Rep. Marilyn Lee (D, Waipio-Crestview-Mililani), said the delay is “inexcusable” because the law was supported by the governor and the community, “even by people not traditionally pro-choice because they saw it as a way to prevent unwanted pregnancies.”

She said implementation should be speeded up, especially since the Food and Drug Administration rejected over-the-counter sales of “morning after” pills earlier this month.

The rulemaking caught people by surprise since the issues had already been aired at legislative hearings, said Kashiwabara, the Pharmacy Association’s government affairs committee chairwoman.

“It is taking a long time,” she said, “and every day that we can’t implement the intent of this law means there are more opportunities for unintended pregnancies and possible abortions being done because we’re not providing access of emergency contraception to women.”

Teshima said she has emphasized to reviewing agencies that “time is of the essence.” The seven-member board is “getting a lot of pressure. People are trying to push it through,” she said.

“But just because we pass a law doesn’t mean we can just dive in and start doing it,” she said, noting a lot of issues about patient safety and the collaborative agreements required between participating pharmacists and doctors.

Physicians won’t be seeing women who ask pharmacists for contraceptive pills, so the agreement spell outs certain steps to determine if they would be effective in each case, rule out possible adverse effects and provide patient care. Pharmacists will try to refer women to a physician if they don’t have one, or to a community health clinic.

Teshima said the Pharmacy Board based Hawaii’s collaborative agreement on those in California and Washington but pharmacists in those states have some prescriptive authority and Hawaii pharmacists don’t, which raised some concerns.

She said the state Attorney General’s Office has reviewed the proposed rules and once the Legislative Reference Bureau looks at them, they will go to the governor and a public hearing will be scheduled.

Kashiwabara said most pharmacists have already been trained and certified by the American College of Pharmacy Education to offer the service. “We’re ready and willing to implement the bill. It’s unfortunate that we’ll have to continue to wait.”

Office of the Governor


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