Last month, four Walgreens pharmacists in Illinois were placed on unpaid leave for refusing to dispense the "morning-after pill," known as Plan B, to patients with valid prescriptions.
It was the first time pharmacists had been suspended under a new and one-of-a-kind Illinois law that says pharmacists must dispense Plan B to women, regardless of religious or personal beliefs.
Ordinarily, pharmacists in most states can refuse to fill prescriptions -- and that's the way they prefer it, according to a recent HCD Research survey. The survey showed 69 percent of pharmacists believed they should have the authority to refuse to fill prescriptions for emergency contraception. On one hand, some pharmacists felt that personal, moral or religious beliefs should allow them the right to decline to fill medication, just as doctors can do. On the other hand, pharmacists also said they had a professional obligation to patients to help them receive medication, no matter what.
Still, pharmacists overwhelmingly supported their own right to decide whether or not to dispense medication. Sixty-three percent of pharmacists surveyed said Walgreens was wrong to suspend the pharmacists. The survey included 859 American pharmacists questioned earlier this month.
This is probably because, as one pharmacist noted, the Illinois state law can put pharmacists in a situation where they are forced to dispense medication even if they feel it could harm the patient.
"You have to dispense it if it's available. Because of that, it means if it is something I know could cause you harm, or I know it's something that could cause a (drug) interaction … that puts the pharmacist at risk, if harm is done," said Gina Smith, president of the Maryland Pharmaceutical Society.
A spokeswoman for Walgreens said that it acted only because of the state law.
"While we absolutely have an obligation to the customer, we do recognize that pharmacists have differences in moral and religious beliefs," spokeswoman Tiffani Bruce said. "In Illinois, it is simply not an option."
One of the pharmacists has since returned back to work, Bruce said.
What is Plan B?
The initial outcry started when Illinois Gov. Rod Blagojevich filed an emergency rule in April that pharmacies that sell contraceptives "must accept and fill prescriptions for contraceptives without delay," according to a news release from his office. Despite pressuring from pharmacists and religious groups, the rule was made permanent in August.
Some people, including pharmacists, consider Plan B an "abortifacient," meaning it induces abortion of an implanted, fertilized egg. That was the reason pharmacist John Menges refused to dispense the drug. He is one of the four suspended Walgreens pharmacists.
"I think they made the wrong decision," Menges, a Catholic, told the St. Louis Post-Dispatch in a Nov. 30 article.
But "abortifacient" is not quite medically accurate. As explained by the federal Food and Drug Administration, Plan B "works like other birth control pills to prevent pregnancy. Plan B acts primarily by stopping the release of an egg from the ovary. It may prevent the union of sperm and egg. If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work."
Regardless, Smith worried that the state law could put Illinois pharmacists in a situation where they would be forced to dispense medication even if they thought it could medically harm the patient.
Striking a balance
"That's a really big concern for me as a pharmacist and as a person who consumes medication," Smith said.
But, as Smith points out, while some women can take their prescription to another pharmacist, having to do so isn't always practical, particularly for women in rural areas or women who lack transportation.
So, rather than having a draconian state law that enforces pharmacists to fill prescriptions no matter what, or having a law that reduces patients' right to receive medication, Minnesota pharmacist Terry Hietpas would like to see laws on the books similar to the one recently signed into law in California. He is director of pharmacovigilance at PROSAR, a product safety call center located in St. Paul, Minn.
That law states that a pharmacist can decline to dispense a prescription if he or she notifies "his or her employer of the objection and it can be reasonably accommodated," along with requiring licenced pharmacies to "establish protocols to ensure a patient's timely access to the prescribed drug or device." Failing to do so could result in a citation.
"The point is to strike a reasonable balance that results in timely access -- and no lectures," he said.