For many women in California, a new law that was supposed to make getting birth control easier has been a little disappointing.
Under the law, women should be able to go to a pharmacy without a doctor's prescription and pick up hormonal contraception, including pills and patches. Although the legislation was passed in 2013, women still struggle to find pharmacists who will dole out the medicines.
Olivia Weber, a law student at UC Irvine, was running low on birth control pills earlier this year when she started looking for a pharmacy that could help. She hoped she could get her prescription renewed without seeing a doctor.
"I was so excited," Weber said, but "I could not find a single pharmacy that was implementing the law."
The holdup in part is because state officials spent months working out details, so the law didn't go into effect until April. But pharmacists aren't required to provide birth control through the law, and many say they're unsure whether they ever will.
"It has so much promise, so it may just be that it's just starting slow," said Virginia Herold, head of the California State Board of Pharmacy. If some pharmacies end up not participating, she said, "it'll be a little more problematic, I suppose, but it won't be any worse than what it was two years ago."
Typically, women have to make an appointment to see a gynecologist to get an annual prescription for birth control. But health advocates argue that creates an unnecessary barrier to contraception that contributes to unintended pregnancies.
Karlie Miller, 28, began calling pharmacies near her home in Redlands after she heard about the law.
Miller is an ideal candidate for pharmacist-dispensed contraception, experts say — she's been taking the same type for 10 years, so she doesn't need to discuss much with a healthcare provider.
But none of the dozen pharmacies she called over the summer offered the service.
"It was just false hope," Miller said.
There's currently no list of how many of the state's 6,500 pharmacies are participating, nor how many pharmacists have completed the required one-hour training, Herold said.
Pharmacists say they're reluctant in part because it could take up to an hour to complete the process for dispensing contraception to women. They must take the patient's blood pressure, administer a questionnaire about health issues that could raise red flags and go over side effects.
"The reality is that to do it right, the pharmacist is going to have to spend some time with a woman," Herold said. "And when that occurs, it's going to slow down things in a pharmacy."
Eventually, Miller found a Vons pharmacy last month that had begun dispensing birth control and obtained a new supply.
"I'm flabbergasted, really, by how long it took," Miller said.
All Albertsons, Vons, Safeway and Pavilions pharmacists in California are now trained to dispense birth control, said chain spokesman Carlos Illingworth. Pharmacy chain CVS is piloting the service at two dozen locations statewide, including five in Los Angeles, while Walgreens and Ralphs are still ironing out details at the corporate level.
Some pharmacists say they're not going to start dispensing under the new law anytime soon because they don't think there's demand for the service. But Jon Roth, chief executive of the California Pharmacy Assn., said he thinks the problem is that women don't know about the new option, not that they wouldn't take advantage of it if it were available.
Nihar Mandavia, a pharmacist who owns the Druggist Pharmacy in Laguna Niguel, said that even before the law took effect, he received calls from women who had run out of birth control pills while waiting to see a doctor and wanted some. He plans to complete his training to dispense contraception soon.
Mandavia said he doesn't think the extra time spent with patients will be a burden for his staff. Pharmacists already offer similar counseling services when selling emergency contraception pills, like Plan B. Plus, taking the time to help customers with such services can give independent pharmacies like his an edge over big chains, he said.
"It kind of helps us even out the playing field," he said.
One remaining issue with the law is cost. Contraception itself is covered by insurance plans under the Affordable Care Act, but many pharmacists charge a fee for the consultation time. (Miller, who went to the Vons in Redlands, said she paid $45.)
The price could be a significant barrier that undercuts the law's goal of easing access to birth control, especially for those who don't have the resources to see a doctor, experts say.
It's unclear whether private insurance companies eventually will cover the cost of the pharmacist consultation, but the state's health insurance program, Medi-Cal, will begin doing so in January under a bill passed last month.
Experts say the Medi-Cal reimbursement is an important step in removing paternalistic barriers to contraception in California. Under another law passed this year, women in the state soon will be able to pick up a year's supply of birth control at once instead of having to stop by the pharmacy each month for a refill.
"We're literally blazing trails here, which is really exciting, and we know it's going to benefit patients," Roth said, "but it is a bit maddening sometimes how slow the process works."