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New York Public Health Now
s2e07 New York's New Contraceptive Standing Order: Improving Birth Control Access Without a Prescription
On this episode of New York Public Health Now, Dr. Shaunna Escobar joins hosts Dr. Jim McDonald and Johanne Morne to discuss New York's new contraception standing order which allows people to get birth control from pharmacies without a prescription. Hear why this was implemented and who it aims to help.
If you have an idea for topics we should discuss, please let us know: PublicHealthNowPodcast@health.ny.gov
Hello and welcome to New York Public Health now podcast. This is where we talk about the why so you can decide what to do. Hello, I'm Dr. Jim McDonald, Commissioner of the New York State Department of Health coming to you again from the 14th floor of Corning tower overlooking Empire State Plaza here in downtown Albany. Our guest today is Dr. Shaunna Escobar. Dr. Escobar is the title 10 Medical Director for New York State and also the Associate Medical Director for the Division of Family Health at the New York State Department of Health. Before we welcoming Dr. Escobar I'd like to introduce my co- host Johanne Morne, Executive Deputy Commissioner. Johanne, how are you today?
Johanne Morne:I am doing well. Thank you so much, Dr. McDonald. It's a pleasure to be here with you, and with Dr. Escobar, welcome, to talk about the New York State contraception standing order, which you and Governor Hochul signed on March 19, authorizing pharmacists to dispense hormonal contraception without a prescription.
Jim McDonald:One of the nice things about the podcast is we can actually dive into issues like this a little bit deeper and just kind of understand and explain all the nooks and crannies about not only what a standing order is but what this standing order actually refers to. So it's great to have Dr. Escobar, who's a family medicine physician by training but also Dr. Escobar did additional training in maternal child health and global health and Dr. Escobar joined us here at the Department of Health last year bringing her rich clinical expertise to benefit the programs in the Division of Family Health that support New Yorkers across their lives from pregnancy, adolescence, and into the reproductive years.
Johanne Morne:Dr. Escobar has a Master's in Public Health from Columbia and an Executive Master's in Health Care leadership from Brown. B efore transitioning to Public Health Dr. Escobar practiced at a residency program, where she mentored and taught the next generation of family medical physicians and emphasize the importance of reproductive health and obstetrics within the family medicine specialty.
Jim McDonald:So great to have you Dr. Escobar. Thanks for joining us today.
Shaunna Escobar:Thank you so much, Dr. McDonald and Joanne, I appreciate the invitation.
Jim McDonald:So we did a little bit of an introduction. But can you tell us a little about yourself?
Shaunna Escobar:Thanks so much for that introduction. I was born and raised in New York, I went to college medical school and obtained my Master's in Public Health here in New York. And although I left the state for residency and fellowship and to teach at a residency program, I am so excited to be home in New York to be working on public health and on projects like the one we're going to be talking about.
Johanne Morne:Yeah, that's great. I took with note you did your Executive Masters at Brown, which was interesting, of course in Rhode Island, where I am and where I moved from here. So I'm, you know, I'm from New York as well, so I'm thrilled to be back, and it's great to see you did your masters at Columbia, you know, you've done a lot and you know, early in your career, you've really accomplished a lot already, which is great. So let's dive into talking a little bit about what a standing order means regarding contraception, or it's also called a non-patient specific standing order. But what is this standing order apply to?
Shaunna Escobar:So a standing order in general allows members of the health team to complete clinical tasks including allowing pharmacists to dispense medications without first obtaining a physician's order. They're carefully designed to reduce errors or adverse events. So this specific standing order applies to persons of reproductive age who are able to get pregnant to obtain hormonal contraception in order to prevent pregnancy. The available methods that people will be able to obtain from the pharmacy will include pills, the patch and the vaginal right.
Johanne Morne:Can you tell us about the mini pill? And specifically, how does it differ from other oral contraceptives, and is it covered by insurance?
Shaunna Escobar:Regular contraceptive pills have a mix of estrogen and progestin in them? The mini pill contains only progestin. And these contraceptive options will absolutely be covered. The mini pill has two different formulations and one formulation is coming over the counter called the Opill.
Johanne Morne:I actually was just reading about that the Opill and what are there if I understand correctly, there are two other forms of birth control covered by the standing order. So a hormonal patch and a vaginal ring. That's correct. And so how are these used and how do they prevent pregnancy?
Shaunna Escobar:Most people are familiar with the pills. Those are the most common forms. The patches is basically a sticker that is put on for a week and replaced every week for three weeks. And then the fourth week, no patch is put on and then the cycle is started all over again. For the vaginal ring, a plastic ring or disc is inserted into the vagina similar to a menstrual cup and that has put in for three straight weeks, it is removed, and left out for a week and then reinserted. Now there are two forms of that vaginal ring one where you get a brand new ring every three weeks and then there's another that you have the same ring for an entire year that is taken out and washed and cleaned every three weeks and reinserted.
Jim McDonald:I want to talk a little bit about the standing order a little bit more detail. These medicines aren't available over the counter, because over the counter means, like Tylenol, you'd walk in the drugstore products on the shelf, and you can go get whatever you want to buy. And you know, Johanne just refer to the Opill is over the counter. But that's not what this standing order covers. So this is different, right? So now these are the same prescription drugs you normally would have gotten from your doctor without a doctor's prescription. It's just that I as the Commissioner, I'm acting as the doctor and I signed the standing order. So if you're a participating pharmacy, folks can do that. But what are people walking into a pharmacy have to do to access these forms of contraception?
Shaunna Escobar:There is a questionnaire that the Department of Health has created to ensure that these forms of contraception are safe. When you go seek contraceptive care at a provider's office, these are common questions that are going to be asked in a visit to make sure that these forms are correct for you. One of the most common things that we're looking for is can you take estrogen? Estrogen can cause heart attacks and strokes and blood clots in certain individuals. So this questionnaire is getting at, are these safe for you? Do you have these risk factors? And so answering this questionnaire, honestly will allow the pharmacists to make sure that these contraceptive pills work for you.
Johanne Morne:So, if you will, back in the day, you know, individuals received a prescription from a physician to gain access to contraceptives or birth control. So what about people who today still have a doctor's prescription? Does the standing order change anything for that individual?
Shaunna Escobar:It won't change anything for them, although it might make it easier for them. Let's say they realize that their prescription needs a refill on a weekend. So they don't have to hound their doctor and figure out how they're going to get this refill on a long weekend or when their doctor is on vacation. So they're able to go in, get a refill on their birth control, and have it be a little bit more hassle free.
Jim McDonald:I guess that would apply to somebody who's visiting from out of state too, right? You know, you came into the city, you're in the
Shaunna Escobar:Absolutely. state on vacation and you forgot your birth control. You could walk into a participating pharmacy and get a prescription for it. Right. That would work too. Right? It would absolutely work that way.
Jim McDonald:And I think if I understand it correctly, you can get up to a year supply, assuming whether your insurance covers it or not, right?
Shaunna Escobar:If your insurance covers that. Absolutely.
Jim McDonald:And my understanding is with the Affordable Care Act, insurance has to give it to you at no copay. Is that still true?
Shaunna Escobar:It is. However, not all formulations are covered all the time. Because oral contraceptive pills, the combination of estrogen and progesterone, there's so many ways that the estrogen and progesterone can be combined, that not every single formulation is preferred by your pharmacy program through your insurance. But your pharmacist will be very helpful in being able to figure out which formulation is covered by your insurance.
Jim McDonald:And we did involve the Pharmacy Association when we did this, right? Like didn't we have some of their help when we're putting this standing order together?
Shaunna Escobar:Absolutely. Yes. Yeah.
Jim McDonald:So let's talk a little bit about who's going to benefit from this standing order. And why did we even do this? Like what was that all about?
Shaunna Escobar:So access to hormonal contraception allows individuals to choose when and if they're going to have a child, and many organizations including the American College of Obstetricians and Gynecologists support straight over the counter access to contraception and access through a pharmacist similar to our programs are at this intermediary while we get more forms of contraceptive over the counter, such as Opill. Opill is a first step, we hope, and more available options over the counter will hopefully be forthcoming.
Johanne Morne:So I want to go back to something that Dr. McDonald's said just a moment ago, and that was about, you know, providing ease of access for the individual who may just be in New York visiting it. Am I right to understand that the standing order applies to anyone, not only New York State residents?
Shaunna Escobar:Anyone who comes, and there is no age restriction either.
Jim McDonald:Yeah, so there is no age restriction. What was our thought process on that?
Shaunna Escobar:Adolescents should have access to the full spectrum of reproductive health care and even in our title 10 programs, adolescents can consent for their own care. If a person of reproductive age who even if it is an adolescent can fill out the questionnaire and understand the risks and can comprehend how to take that method, and the pharmacist thinks that all of those criteria are met, then that individual can be dispensed contraception.
Johanne Morne:So one of the things I often say is that I'm always proud to live in New York State and there are a number of reasons behind that. But one of the reasons is because of the progressive thinking and the protections that we put into place for individuals. You know, as we're talking here today, I keep thinking about the fact that this is a major step forward as it relates to health equity and as it relates to women's reproductive rights at a time when there are other jurisdictions and states that are doing perhaps the exact opposite. Do you know of any other states or jurisdictions around the country that are taking similar actions or have put standing orders in place?
Shaunna Escobar:According to the Guttmacher Institute, there are about 27 states including the District of Columbia that have a program like ours. Each state program is slightly different. Some require the person receiving birth control to have seen a reproductive health care provider within the past year, New York does not have that restriction. Other states only provide this for individuals over 18, we've talked about adolescents can still have access to our program. However, some states include the Depo shot, which is a progestin only injectable every three months, New York does not have that option at this time. We are certainly in alignment with the majority of other states who have this program available.
Jim McDonald:You just remind me that not everybody has a doctor, by the way, or a place where they can get medical care for whatever reason, and of course, those are issues that are important too, but this could be a way they could access contraception, where they normally couldn't, is that your understanding as well?
Shaunna Escobar:There are many reasons as you mentioned, why providers may not be accessible. And I also want to highlight that the New York State family planning program is a way to access contraceptive care, and also the full spectrum of reproductive health care within New York State. And we have a way on our website for individuals who are looking for those providers to be able to find that at free or low cost, depending on income.
Jim McDonald:So it's going to take a while for pharmacies to onboard, you know, they have to do some training. How popular do we think this is going to be? Any idea how many people are going to take advantage of this or what percentage of pharmacies are going to participate?
Shaunna Escobar:So when we look at other states that do a program similar to ours, we look at Oregon, which is one of the states that have been doing this for a long time, and they estimate about 10% of their Medicaid population gets their birth control from a pharmacist directly. So that's not insignificant.
Johanne Morne:So I really appreciate this conversation as it relates to reproductive rights as it relates to pregnancy prevention. But can we talk about, you know, for example, I want to make sure that our listeners know what this doesn't doesn't do. Do these contraceptives, prevent sexually transmitted infections?
Shaunna Escobar:They do not. They only prevent pregnancy. And so wearing condoms is still very important to prevent sexually transmitted infections. If you would like to be tested for sexually transmitted infections, going to a Family Planning Center or to a provider to get tested for sexually transmitted infections would be very important.
Johanne Morne:Agreed. I often say when when we talk about contraception, it's not an either or it can be an and looking at all the options available to us is really important.
Jim McDonald:We've been talking to Dr. Escobar, the New York State Department of Health. We talk about the why. And sometimes we'll talk about the what. Today we've talked about a non-patient specific standing order for contraception in New York State that went into effect last month, whether it's the pill, the patch, or the ring you can go into participating pharmacy, and get a prescription filled for a contraceptive, and why we did it was to improve access to care, make it more convenient, and help people have children when it's their timeframe. So that's really why we did all this. So it was great to have Dr. Escobar for taking the time to join us today.
Shaunna Escobar:Thank you so much for having me.
Jim McDonald:So that's gonna do for today's episode of New York Public Health now podcast. As always, if there's a topic of interest you would like to hear us talk about please let us know by email at PublicHealthNowPodcast@health.ny.gov. Keep an eye out for the latest New York Public Health now episode on your favorite podcast player like Apple podcasts, Overcast, Spotify, YouTube and Google podcasts. Search by our podcast title, "New York Public Health Now" or the keyword NYSDOH, then tap the subscribe or follow button to be notified when we release a new episode which is about every other week. For the New York Public Health now podcast, I'm Dr. Jim McDonald.
Johanne Morne:I'm Johanne Morne.
Shaunna Escobar:And I'm Dr. Shaunna Escobar.
Jim McDonald:And thank you for listening.
Monica Pomeroy:New York Public Health now is a production of New York State Department of Health's Public Affairs Group. Michael Wren is the executive producer and engineer with additional production support provided by Sarah Snyder,. Genine Babakian, and Barbara Stubblebine, Alicia Biggs, Monica Pomeroy and Kyle Kotary. Copyright 2024 All rights reserved. We welcome your feedback. Please email us at PublicHealthNowPodcast@health.ny.gov.
