A new law in California allows women to pick up birth control pills from pharmacies without a doctor's prescription.
But more than a year after the law took effect, women say they're still struggling to get the medicines, in part because they can't find pharmacies offering them.
A study released Tuesday in the Journal of the American Medical Assn. found that only 11% of pharmacies in the state are dispensing hormonal birth control to women without prescriptions. Pharmacists don't have to make use of the law, and some are reluctant to because they're concerned about liability, adequate staffing and a lack of reimbursement for the service, the study found.
Also at play is a supply-demand problem, experts say: Pharmacists don't want to invest in providing the service if women don't want it, but women aren't aware it's an option and aren't asking for it because pharmacies aren't offering it.
"It's hard to have demand for a service that doesn't exist," said UC Berkeley professor and study author Anu Manchikanti Gomez.
Typically, women have to make an annual appointment to see a gynecologist to get a prescription for birth control. But health advocates argue that the doctor visit requirement creates an unnecessary barrier to contraception.
California's law doesn't make birth control over the counter. Instead, a pharmacist can provide hormonal birth control to a woman after administering a questionnaire about health issues that could raise red flags.
Ariel Genovese, 32, recently called several pharmacies near her home in Oakland about the law. Some pharmacists told her there wasn't protocol from management to implement the law, and others said they hadn't heard of it at all.
"I honestly gave up on it," said Genovese, who works as an executive assistant.
Between February and April, interviewers posing as patients called 1,008 of the 5,291 community-based retail pharmacies in California and asked about obtaining birth control, according to the study.
About 1 in 10 pharmacies said it was offering the service, Gomez said, and there was no difference between rural and urban areas or chain and independent pharmacies.
Virginia Herold, executive officer of the California Board of Pharmacy, said she expected a slow rollout of the law but was a little surprised by the results.
"I think everyone kind of thought it would probably be higher than 10%," Herold said.
The law is part of a broader trend in healthcare in which pharmacies are transforming into places for people to seek medical care, such as flu shots and checkups, as opposed to just pick up medicine, experts say.
Herold said more pharmacists may complete the one-hour training to participate in the law and begin dispensing birth control in the coming months. A third of pharmacies that weren't offering the service said they planned to in the future, Gomez said.
In California, all Albertsons, Vons, Safeway and Pavilions pharmacists were trained to dispense birth control as of late last year. Most Ralphs pharmacists are trained in the law, CVS is rolling out the service at 120 locations statewide, most of which are in Los Angeles, and Walgreens is testing it at a small number of locations in the state, according to company officials.
One big hurdle is payment, experts say. The birth control itself is covered by insurance plans under the Affordable Care Act, but pharmacists can charge for counseling patients and furnishing the medication. Vons charges $45 for the service.
"Personally, that's a bit steep for me right now," said Genovese, who has insurance through Covered California. "If I need subsidized insurance and help paying for [birth control], I probably don't want to pay an extra fee on top of it."
California lawmakers approved a law last year requiring that Medi-Cal, the state's low-income health program, cover the pharmacist fee, but the details are still being resolved and it probably won't go into effect until next year, said Anthony Cava, spokesman for the state Department of Health Care Services.
Once Medi-Cal begins covering the fee, insurance companies may start following suit, which would make obtaining birth control from a pharmacist more widespread and accessible to women, experts say.
"I really do think the landscape may change a little bit if it becomes easier to get reimbursed," Herold said.