Women in Arizona may soon find it a lot easier to get to get birth control.
On a 32-24 vote, the House on Monday approved allowing pharmacists to dispense certain kinds of contraceptives without getting a prescription. More to the point, it would eliminate the need to first go to a doctor.
SB1082 would have Arizona join more than a dozen states that already have eliminated the requirement for a prescription.
But the change, which still requires Senate ratification, does not mean women could simply march in to a pharmacy and demand birth control of their choice.
Pharmacists would first be required to screen would-be recipients to determine if they are candidates for the kinds of contraceptives that use hormones. That includes not just the birth control pill but also other hormone-infused devices like a vaginal ring and patches.
And only those 18 and over are eligible.
At the heart of the debate is how difficult it should be for women to avoid conception.
“Pregnancy should be the decision of the woman,” said Rep. Athena Salman, D-Tempe.
“Right now women face barriers in our community because they don’t have access to doctors for a variety of reasons, one of which is because health care premiums keep going up,” she continued. “We should be making it as accessible as possible for women who want to plan their pregnancies to be able to do that.”
No one spoke against the idea of easier access. But several wanted more guardrails.
Rep. Joanne Osborne, R-Buckeye, said she has no problem with women getting up to two years of refills without having to go back to a doctor.
She proposed, however, that any initial prescription require an order from a physician. And there would need to be new medical assessment performed by the woman’s primary care physician every other year.
Rep. Regina Cobb, R-Kingman, who is a dentist, said that is designed to ensure that the chemicals in the contraceptive devices are not causing problems. She noted a link between certain types of birth control, particularly those using estrogen, and potentially fatal blood clots.
“Prescribing without actually doing a complete exam and questionnaire from a medical professional I think is irresponsible,” Cobb said.
But Rep. Randy Friese, D-Tucson, who is a doctor, said he doesn’t see that as necessary.
He pointed out that SB1082 still requires patients to fill out self-assessments. Those would have to be reviewed by a pharmacist before dispensing any form of birth control.
Friese said, for example, a pharmacist would not prescribe a form of birth control with estrogen to someone who is a smoker or over a certain age, both of which he said are risk factors for clots. But he said they may be good candidates for contraceptives with progesterone.
He said the questionnaire also would point up other risk factors that would cause a pharmacist to decline to provide hormonal birth control, like pregnancy. It also would disclose other conditions like breast feeding or diabetes that might be affected by hormones.
Cobb said that’s hardly enough.
She said her own patients, filling out questionnaires at her office, might answer one way in writing. But when questioned in person, where more detail can be solicited, Cobb said sometimes the answers change.
And that, she said, makes what’s in SB1082 inappropriate.
“We’re taking about medications here that could be life threatening,” Cobb said.
“And yet we’re taking it lightly as if it’s taking an ibuprofen or an aspirin,” she continued. “And that’s not what this is about.”
Rep. Kelli Butler, D-Paradise Valley, agreed that every women should see a doctor every two years.
“And that would be better,” she said. But Butler said it doesn’t match reality.
“In fact, many, many people in Arizona don’t have insurance, don’t have the opportunity can’t afford to go see a physician, don’t have the time,” Butler continued. “Of course we want people to take the time for their own health but the reality it sometimes it doesn’t happen.”
Butler also suggested that foes of birth control without a prescription were not being consistent.
“That is more than is required for taking a drug like Viagra, for example,” she said.
“For Viagra, there are serious side effects including cardiovascular problems, heart attacks,” Butler said. “I mean, people could die and we’re not so worried about that.”
But Butler conceded after the debate that it remains a legal requirement to get a prescription for Viagra.
The measure still needs approval by the Senate. That’s because the version previously approved there had something the House found unacceptable: immunity for pharmacists from civil suits for damages resulting from their decision to dispense contraceptives.