Indiana follows a growing trend where states are expanding pharmacist prescriptive authority. On May 01, 2023, Indiana Governor Eric Holcomb signed House Bill 1568, (the “Law”) which adds a new code section, Indiana Code 25-26-25 and related conforming changes. The Law allows pharmacists to prescribe and dispense “self-administered hormonal contraceptives” (contraceptives) according to a state-issued standing order. Contraceptives that pharmacists can prescribe include hormonal pills or patches, and are drugs composed of a hormone or a combination of hormones approved by the federal Food and Drug Administration (FDA) that the woman self- administers. Contraceptives do not include drugs or substances that contain a progesterone receptor antagonist.
Medicaid Coverage
The Law directs the U.S. Department of Health and Human Services (HHS) to amend the Indiana Medicaid plan. The plan amendment adds reimbursement to pharmacists and pharmacies for services and prescriptions under the Law that are provided to eligible Indiana Medicaid beneficiaries. The plan amendment must be completed by July 1, 2023.
Pharmacist Prescriptive Authority
Before September 1, 2023, the state health commissioner or a designated public health authority must issue a standing order allowing pharmacists to prescribe and dispense contraceptives. Before issuing the standing order, the state health commissioner or designated authority must consult with appropriate medical experts and receive approval from the Indiana Board of Medicine. The Board of Pharmacy ("Board") will then adopt rules incorporating the requirements outlined in the standing order. The timing for the new regulations is not yet determined.
The state-issued standing order will require pharmacists who elect to prescribe contraceptives do the following:
- Complete Board approved training.
- Provide patients with a self-screening tool to assess risk and that must be completed before the pharmacist prescribes the contraceptive.
- Refer the woman to a primary care practitioner upon prescribing and dispensing the contraceptive.
- Provide the woman with a written record of the contraceptive and advise the woman to consult with a primary care practitioner or women’s health care practitioner.
- If the pharmacist works at a site which, in the regular course of business has a provider who is a physician, advanced practice registered nurse, or physician assistant who is available to deliver patient care and who is capable of prescribing contraceptives, suggest that the woman see the provider.
- Administer the screening protocol before issuing each prescription for a contraceptive.
- Communicate that a prescription for a contraceptive patch or self-administered hormonal contraceptive may not be for more than six (6) months, and that the pharmacist may not issue a prescription to the woman after twelve (12) months unless the woman has been seen by a physician, advanced practice registered nurse, or physician assistant in the previous twelve (12) months.
Overall, while expanding the authority for pharmacists, the rules outlined above also indicate that the legislature does not view the pharmacist delivered care as a substitution for the patient’s relationship with a more traditional prescriber as well.
In addition, the pharmacy or pharmacist may not require the patient to schedule an appointment with the pharmacist before the pharmacist prescribes or dispenses contraceptives. Finally, pharmacists may decline to prescribe or dispense contraceptives if they have an “ethical, moral, or religious” objection to contraceptives. Similarly, pharmacy technicians can also use these reasons to decline to dispense contraceptives.
Under the new law, the Board can revoke a pharmacist's license if the pharmacist knowingly or intentionally prescribes a drug intended to cause an abortion. Pharmacists knowingly and intentionally prescribing a drug intending to cause an abortion can now be charged with a Level 5 felony.
The final enrolled Bill can be found here: House Enrolled Act No. 1568
