Four bills filed in the General Assembly have thrust Missouri into the national debate about whether pharmacists have the right to refuse to fill certain prescriptions, primarily emergency contraception known as Plan B, or the morning-after pill.
Bills filed by Democrats in the Missouri House of Representatives and Senate would require pharmacists to either fill prescriptions for emergency contraception in a timely manner or help patients find pharmacies that will. Competing bills filed by Republicans, however, would do the opposite, allowing pharmacists to refuse prescriptions they think will be used for abortions and prohibiting them from discriminating against employees who oppose such prescriptions.
Plan B is a high dose of birth control medicine that can prevent pregnancy for up to 72 hours after unprotected sex. It will not work if a woman is already pregnant and is not the same as the RU-486 drug that can cause an abortion up to seven weeks into a pregnancy.
The differentiation between the drugs only fuels the debate.
“Missouri says that life begins at conception, and this drug (Plan B) is designed to kill that life,” said Sen. Jason Crowell, R-Cape Girardeau, said. “It’s no different than a partial-birth abortion.”
Democrats see a difference.
“The Republicans are misleading the public and misleading the legislature into thinking that these two drugs are the same thing,” said Pamela Sumners, executive director of NARAL Pro-Choice Missouri. “The people of Missouri deserve better than that.”
Missouri has no monopoly on the debate. States across the country have begun to wrestle with the issue as the Food and Drug Administration considers whether and how to make Plan B available over the counter. The FDA Advisory Board in 2003 voted 24-3 to do so, but senior FDA officials began a complicated rule-making process that could take several years. Barr Pharmaceuticals, the company that produces Plan B, recently submitted a petition to make the drug available over the counter to anyone older than 17.
The delay stirred some states to take on the issue themselves. Arkansas, Georgia, Mississippi and South Dakota all have laws allowing pharmacists to refuse prescriptions for emergency contraception. Alaska, California, Hawaii, Maine and New Mexico made emergency contraception available without a prescription.
In Illinois, Gov. Rod Blagojevich last year mandated that any pharmacy that stocks birth control must also carry emergency contraception. Illinois is the only state with such a policy. Walgreens faces a lawsuit filed Friday by four employees of several Walgreens pharmacies in southwest Illinois.
Several companies have policies regarding emergency contraception. Wal-Mart has refused to fill such prescriptions since 1999. Target requires pharmacy employees to sign a “conscience clause policy” declaring that if they will not fill prescriptions for emergency contraception, then they will refer patients to Target pharmacies that will. Earlier this month a Target pharmacist in St. Charles was fired for refusing to refer a patient seeking emergency contraception to another pharmacy. She filed a complaint last week with the Equal Employment Opportunity Commission.
At the national level, the FDA has indefinitely delayed a ruling on whether Plan B should be available over the counter. In 2003, the FDA Advisory Board voted 23-4 to approve over-the-counter sales of Plan B, but senior FDA officials began a complicated rulemaking process that may take several years.
In Missouri, Senate Bill 943 would strive to prevent unwanted pregnancies by changing Missouri’s sex education laws, restoring funding for the Women’s Health Services Program and enacting several patient-protection provisions. That bill was filed by Sen. Joan Bray, D-St. Louis, and is co-sponsored by five Democrats, including Sen. Chuck Graham, D-Columbia. It has been referred to the Judiciary and Civil and Criminal Jurisprudence Committee for a hearing.
In the House, Rep. Robin Wright Jones, D-St. Louis, has filed a companion bill, HB 1520, with both Republicans and Democrats as co-sponsors. Reps. Jeff Harris and Judy Baker, both Columbia Democrats, are among them.
Bray said she crafted her bill because she thinks pharmacists should avoid playing doctor and simply fill prescriptions that patients bring.
“I was at a panel discussion the other day where a pharmacist said, ‘A pharmacist’s mission is to be patient-centered, not self-centered,’” she said.
“With this bill, the burden would be on the pharmacy to fill the prescription in a timely manner or find someone who can, not on the individual to find somewhere else to go,” Bray said.
Graham is co-sponsoring the bill because “he felt that prevention of an unwanted pregnancy is a way to make abortions more rare,” said his chief of staff, Ted Farnen.
The NARAL Pro-Choice Missouri Foundation says Bray’s bill should win support even from people who oppose abortion.
“If you are someone who wants to lessen abortions, you don’t throw stumbling blocks into the way of doing that by giving pharmacists the unqualified right of not filling perscriptions for emergency contraception,” Sumners said.
Sumners and Bray hope the bill will at least start a dialogue between supporters and opponents of abortion rights.
“If it doesn’t pass, at least it will put people who aren’t flexible in the position to defend their flat-Earth indefensible policies,” Sumners said.
A survey last spring by NARAL Pro-Choice Missouri found that 71 percent of the 920 pharmacies surveyed did not stock emergency contraception and that only 39 percent of those will order it if asked. In Columbia, the survey found that 11 of 15 pharmacies, as well as Columbia’s Planned Parenthood clinic, carry Plan B. Representatives of four Columbia pharamacies that do not stock emergency contraception declined to comment Monday.
The Republican bills, Senate Bill 609 and House Bill 1539, want to make it illegal for pharmacists to be fired or discriminated against because of their moral, ethical and religious beliefs or refusal to fill prescriptions that go against those beliefs.
The sponsor of theSenate bill, Crowell, says he is just trying to give pharmacists the same protection that nurses and doctors already have.
“It’s important that pharmacists know that just because they go to school and get a great education you don’t have to check your morality at the door,” Crowell said. “I mean, this is America, this is Missouri, this is the kind of stuff they do in Russia.”
The bill’s co-sponsor, John Cauthorn, D-Mexico, doesn’t understand the other side of the argument.
“It’s really just a common sense issue to me, someone can be fiercely pro-life and be forced to do something that is against their good faith beliefs,” Cauthorn said. “I’m just not sure that’s right.”
Missouri Pharmacy Association CEO Ron Fitzwater attributes the low percentage of pharmacies carrying the drug to its high cost and to low demand in rural areas. Depending on insurance coverage, prescriptions for Plan B can cost as much as $61.
Fitzwater said requiring pharmacists to fill prescriptions for emergency contraception would be unfair.
“Are we going to start mandating that Catholic hospitals do abortions?” Fitzwater asked. “Why should we single out pharmacists and force them to fulfill a policy that isn’t suitable for their business plan?”
Fitzwater also worries that the bill in conjunction with “unrealistic regulatory burdens” and the new Medicare and Medicaid systems will put some rural pharmacies out of business, forcing some people to drive long distances to get their medicine.
“This bill is an unrealistic mandate on businesses in Missouri,” Fitzwater said. “If you’re going to have a capitalistic society, you have to let business owners decide what’s best for their own businesses.”