Hearing: Freedom of Conscience for Small Pharmacies
House Small Business Committee, Washington, D.C. 25 July, 2005
Prepared Remarks of Mr. J. Michael Patton, M.S., CAE
Executive Director Illinois Pharmacists Association
Full Text
Unfortunately, what we are now finding is
that some individuals are now testing select pharmacies to discern
the willingness of the pharmacy to fill their prescription. A case
in point is a woman who would drive over 100 miles to a very small
rural pharmacy to get her prescription filled when she had passed
multiple metropolitan areas.
Good Morning and thank you to Committee Chair Congressman
Manzullo for inviting me to speak today before this committee on the
issue of Freedom of Conscience for Small Pharmacies.
Ladies and Gentleman of the House Committee on Small Business!
On April 1st Illinois' Governor Rod Blagojevich
invoked an emergency rule requiring all Illinois licensed pharmacies
to provide contraceptives based on a valid, lawful prescription
without delay. As initially implemented, this emergency rule posed a
substantial risk to patient care and created a substantial challenge
for pharmacists licensed in our State.
Since that time, the emergency ruling has been modified and
proposed language will be reviewed by our Joint Committee on
Administrative Rules on August 16th. The language as now
being promulgated is as follows:
" Duty of Division I Pharmacy to Dispense
Contraceptives
1) Upon receipt of a valid, lawful
prescription for a contraceptive, a pharmacy must dispense the
contraceptive, or a suitable alternative permitted by the
prescriber, to the patient or the patient's agent without delay,
consistent with the normal timeframe for filling any other
prescription. If the contraceptive, or a suitable alternative, is
not in stock, the pharmacy must obtain the contraceptive under the
pharmacy's standard procedures for ordering contraceptive drugs not
in stock, including the procedures of any entity that is affiliated
with, owns, or franchises the pharmacy. However, if the patient
prefers, the prescription must either be transferred to a local
pharmacy of the patient's choice or returned to the patient, as the
patient directs.
2) For the purposes of this subsection (j),
the term "contraceptive" shall refer to all FDA approved drugs or
devices that prevent pregnancy.
3) Nothing in this subsection (j) shall
interfere with a pharmacist's screening for potential drug therapy
problems due to therapeutic duplication, drug-disease
contraindications, drug-drug interactions (including serious
interactions with nonprescription or over-the-counter drugs),
drug-food interactions, incorrect drug dosage or duration of drug
treatment, drug-allergy interactions or clinical abuse or misuse,
pursuant to 225 ILCS85/3 (q)."
As the ruling is now being enforced, the Illinois Pharmacists
Association has taken a formal position that we can accept and
support these modifications. However, we feel it is imperative that
the reference to "health care personnel" as cited in the Illinois
Health Right of Conscience Act must be amended to specifically
include pharmacists by reference rather than just by inference as
"health care personnel".
The initial impact of this edict was harrowing for Illinois
pharmacists as many of the small, rural communities did not carry
emergency contraceptive indication referred to as Plan B. These
pharmacies did not stock this item because of any personal or
religious beliefs but rather the simple principles of supply and
demand. If there is no demand there is no reason to inventory this
product. The reality of many of these small pharmacies in these
remote communities is that if a woman has unprotected sex and
determines with the advice of her physician that pregnancy could be
eminent, then she will seek out a pharmacy in a nearby metropolitan
area to preserve and protect her privacy and anonymity.
Now these pharmacies are being challenged as to how to respond to
the new ruling of the Governor. Most still do not carry this
product, but have established a relationship for a personal referral
with a nearby "chain store" who now will typically stock this
product due to the new mandate and the corporate requirement for
compliance. The ruling provides for the ability for the pharmacist,
with the patient's permission, to transfer the prescription to a
local pharmacy of the patient's choice or return the prescription to
the patient.
Unfortunately, what we are now finding is that some individuals
are now testing select pharmacies to discern the willingness of the
pharmacy to fill their prescription. A case in point is a woman who
would drive over 100 miles to a very small rural pharmacy to get her
prescription filled when she had passed multiple metropolitan areas.
This initiative has been utilized now at several pharmacies that
happen to be owned by Illinois legislators. This has caused concern
and fear of many rural pharmacies that they may also be targeted in
this "plot" to coerce pharmacies into compliance; thereby creating
the need for many pharmacies to now "inventory" this product in the
event they might be "tested"!
This situation has caused many pharmacists to examine their own
profession and dedication. They feel they no longer have the right
to determine their own fate in the dilemma of dispensing. Should
they or shouldn't they dispense? Pharmacists are now beginning to
question their rights under this new mandate. Irrespective of their
own personal beliefs, many pharmacists are now facing the reality if
it is oral contraceptives today, what might the prescription be that
will be mandated tomorrow?
Pharmacists are health care professionals, as defined in Illinois
statute, and expect to be treated as the professionals that they are
trained to be. The commitment of the pharmacist is to serve and
protect the health and safety of their patients. This can quite
easily be met by allowing pharmacists to do as they always have; if
a medicine is not in stock, they may offer to order it for the
patient or in the event of a time sensitive prescription like "Plan
B", they may make a referral to a local fellow professional.
This ruling has created limited economic hardship on many small
pharmacists, but the threat of a noncompliance complaint for
legitimately not having this product in stock has created a much
greater burden on all pharmacists. As a result, some pharmacists are
questioning the viability of maintaining their practice in the State
of Illinois. Some with whom I have spoken, are contemplating
relocating into other nearby States that will allow them to practice
without fear of intervention. This consideration, will undoubtedly
have significant impact on the availability, affordability and
access to quality healthcare in many remote rural areas, rendering
those patients in greatest need to drive greater distances to have
their prescriptions filled. Only time will tell the true cost
implications of these decisions. Pharmacists by nature are quite
diligent in their efforts to comply, but the outside influences of
certain "activists groups" testing selected pharmacists has created
a noose of fear that is greater than any inventory item.
These pharmacists fear their license may be in jeopardy if they
fail to comply with a mandate such as this irrespective of their
personal beliefs. The cost of compliance has become an emotional, as
well as an economic burden.
The Illinois Pharmacists Association has also urged the Governor
to give further consideration, to recognize the right of conscience
for pharmacists, but for those choosing to be trained to do so; we
suggest allowing properly trained pharmacists to dispense "Plan B"
without a prescription under the formal protocols of a licensed
physician. This is now being done in at least 6 other states. This
would allow pharmacists to be properly trained to counsel and
dispense, and pharmacies to publicly advocate their willingness to
dispense emergency contraception without a prescription. This we
feel addresses the availability of emergency contraception, and also
provides the potential for savings as well.
Thank you ladies and gentlemen for the privilege and opportunity to
be with you today, and I will be happy to try and address any
questions that you might have.