May 26, 2025 • 28 mins
With over-the-counter birth control expanding access to contraception, pharmacists have a growing role in guiding patients through their options, ensuring safe use, and providing essential counseling. This episode explores the pharmacist’s role in OTC birth control recommendations, patient education, and broader hormonal contraception services within community pharmacy practice. Tune in to learn how you can confidently support patients in making informed decisions about their reproductive health.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Kate Riddell, PharmD, MS
Pharmacist
Consultant/CPESN IN
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Looking for more information on Over-the-Counter Contraception? Check out our course, Pharmacist Prescribing of Hormonal Contraceptives: An Advanced Training!
CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Explain the pharmacist's role in recommending and counseling patients on over-the-counter birth control and other hormonal contraception options.
2. Identify key safety considerations, eligibility criteria, and best practices for providing contraception services in a community pharmacy setting.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-191-H01-P
Initial release date: 5/26/2025
Expiration date: 5/26/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, and, as always, I'm excited about
our conversation today.
Access to birth control isevolving and pharmacists are at
the forefront of expandingcontraceptive care through
over-the-counter options andpharmacy-based services.
In this episode, we'll discussthe role of pharmacists in
(00:25):
guiding patients on OTC birthcontrol, counseling on hormonal
contraception and ensuring safe,informed reproductive
healthcare decisions.
And it's so great to have KateRydell back as one of our guest
experts in this episode.
We had you on gosh, probablyback in the fall, discussing OTC
cough and cold recommendations.
(00:46):
So, kate, thanks for joining usagain.
It's good to have you back.
Speaker 2 (00:49):
Yes, thank you, I'm excited to be here.
Speaker 1 (00:51):
Yeah.
So if you weren't able tolisten to the previous recording
with Kate, I'll give her anopportunity to kind of introduce
herself, talk a little bitabout her practice site, her
role and her passion for today'stopic, and then we'll jump into
content.
Speaker 2 (01:06):
Absolutely.
Thanks, Josh.
My name is Kate Rydell and I ama practicing community
pharmacist.
I practice at an independentcommunity pharmacy in Indiana
and there I actually am able toprescribe hormonal
contraceptives, which we'll talka little bit about in this
podcast, as that is somethingthat pharmacists can do in
Indiana.
And then we do stock Ophil, theOTC birth control.
(01:28):
So those are some of the thingsthat I do there.
I'm also on a grant funded teamfor expanding pharmacy access
to hormonal contraceptives forHoosiers.
It's called the Patch Project.
So I do a lot of work in thisspace and I'm excited to be here
as a guest and talk a littlebit about Ophil today.
Yeah, and I'm excited to behere as a guest and talk a
little bit about Ophel today,yeah.
Speaker 1 (01:44):
So again, thanks for taking time out of your busy
schedule.
Sounds like you have yourplates full, so we appreciate it
very much.
So, kate, you've been herebefore.
You know the drill, so you knowI like to jump right in and get
started on content.
So let's talk about, if you canjust remind us of, I guess, the
inception, the beginning ofbirth control in general, and
(02:07):
then kind of when OTC birthcontrol came on the market and
why that's kind ofrevolutionized some things and
why we need to talk about it.
Speaker 2 (02:15):
Yeah, so we've had some hormonal birth control
options since I don't want tosay the exact year in here, but
kind of the 1960s to 1970s yearin here, but kind of the 1960s
to 1970s and actuallynorgesterol, which is the
synthetic progestin that is inOPIL, the OTC birth control, was
approved for prescription usein 1973.
So that's been around for quitesome time Now.
(02:36):
That shift to us having thatover-the-counter birth control
product which was due to HRPharma actually applying to
change the status of norgesterolfrom prescription only to
over-the-counter use.
And so when I was preparing forthis podcast I looked a little
bit into what does that processactually look like?
And essentially, when you wantto change something from a
prescription-use product only toan over-the-counter-use product
(02:59):
, you have to be able todemonstrate that the product can
be used by consumers safely andeffectively without huge
healthcare professionalintervention, so that you know
the marketing for the medication, the drug fact information
labels that we see on thoseover-the-counter products that
you know.
These are easy enough things formost folks to understand
without having that healthcareprofessional interaction that is
(03:23):
often, often, will always,needed for prescription use
products.
So essentially just meaningthat those drug fact labels are
easy to understand.
And so they got that approvalin July of 2023 from the FDA,
and so we, since then that iswhen we've had our first
over-the-counter progestin onlyhormonal birth control option,
and this is something that Iknow has been in the making and
(03:46):
that ACOG has definitelyrecommended over-the-counter use
to increase access.
So this is super exciting.
Even on the FDA approval letterdescribing this new approval
for Opil nogesterol, they talkedabout how that increase in
access and how that is supercritical.
They talked about how thatincrease in access and how that
(04:07):
is super critical.
I'm actually going to glancehere on that approval.
They said that almost half ofthe 6.1 million pregnancies in
the United States each year areconsidered unintended.
So if we can improve access tobirth control.
We can bring that number downbecause we know that unintended
pregnancies can have been linkedto negative maternal outcomes,
including reduced likelihood ofreceiving early prenatal care
(04:28):
and increased risk of pretermdelivery.
So access to hormonal birthcontrol options can be really
critical for reducing thatunintended pregnancy rate and
also improving maternal outcomes.
Speaker 1 (04:40):
Yeah.
So the impact of this movingover the counter is just is is
even greater than just the factof oh, now it's easy for anyone
to have access to it.
Like it just yeah.
Speaker 2 (04:50):
So yeah, so much further than that.
Speaker 1 (04:52):
Yeah, that reach is just so great.
So one thing I would ask thatremind all listeners in case
they don't stock it is thissomething that has to be in a
specific area?
Is it just randomly on a shelf,any shelf of your choice, like
just maybe kind of review thoseparameters there?
Speaker 2 (05:07):
Yeah, absolutely so.
Opil can go anywhere in yourshelf.
I know some pharmacies havechosen to keep it behind the
counter so that folks areprompted to ask pharmacist
questions before getting it, butthat's, honestly, isn't always
recommended.
We want it to be easy accessand out on the shelves in the
pharmacy so.
I know where I work as apharmacist.
We have it with prenatalvitamins, pregnancy tests,
(05:30):
fertility, just other preventionstrategies.
The family planning area is thesection that we have it in,
Although you might, you couldput it in other sections too,
but there's not really anyrestrictions or guidance.
Speaker 1 (05:44):
Okay, yeah, and you know one thing to your point.
I understand why some wouldmaybe want to keep it behind the
counter to make sure thatquestions are being asked and
that they're really guiding.
But, as you mentioned, thatkind of defeats the whole
purpose, because the wholepurpose was to get it over the
counter that maybe there'ssignage that you put near it
(06:11):
that this is a new product.
We'd love to help you answerany questions you have so that
at least it directs them back tothe pharmacy team to ask
questions, absolutely.
Speaker 2 (06:17):
Another thing you could do is our family planning
section is in an area that'sreally easy for me to see from
behind the pharmacy counter.
So if I see somebody spendingsome time over there, it's
really easy for me to go overthere and just ask if they have
any questions or just let themknow.
Hey, if something does come upthat you want to ask me, like I
am here, like I see you.
Also, I do like the idea of thesignage, especially some of our
(06:40):
younger patients.
There's a lot of studies comingout that suggest that some
younger patients don't alwayswant to go ask questions.
So if we can put the signageout that maybe addresses those
questions and kind of think youknow what are the most common
things that my patients aregoing to want to know about this
and have specific signage forthat, we can still answer their
(07:00):
questions without them having tohave that direct conversation
with us.
Another thing is I know a lotof pharmacies, including mine,
have like a patient messagingportal, so that might be another
way that we can encouragepatients to ask us questions.
So a couple of different thingsthat we can utilize to make
sure that we're keeping OPILaccessible but also making sure
(07:23):
that we are readily available inwhatever format patients prefer
to answer questions.
Speaker 1 (07:28):
Those generational differences, those kids of today
love to text.
They don't like to directconversation or face-to-face
even.
Speaker 2 (07:36):
And they text us on our pharmacy system.
Speaker 1 (07:40):
So it can be another great avenue.
Yeah, good call out.
We've kind of talked about therole of hormonal contraception
in general and its inception andwhatnot, but let's just
reiterate pharmacy's expandingrole, the pharmacist's expanding
role in this space.
So, obviously, what should webe doing in the space of
hormonal contraceptive care?
Speaker 2 (07:59):
Oh, that's a loaded question, Josh.
I mean, it kind of depends onwhat state you're in.
Speaker 1 (08:04):
That's fair fair yeah .
Speaker 2 (08:07):
More than 30 states right now have some kind of
legislation that allowsprescribing of hormonal
contraception in some format.
Now it looks different state tostate, so it might be through a
standing order, it might bethrough a statewide protocol.
Some states have utilizedcollaborative practice
agreements to do this, or theyhave a blanket like prescriptive
(08:27):
authority to do this, or theyhave a blanket like prescriptive
authority, and then the methodsthat pharmacists can prescribe
alter state to state.
Most states that have thispermission allow pharmacists to
prescribe the pill, but some canalso do the patch, the ring and
the depo shot.
Speaker 1 (08:40):
Injection yeah.
Speaker 2 (08:41):
So if you're listening to this and you're
like I have no idea what I cando, in my state there's a couple
of references.
So birth control pharmacistkeeps an updated list, and so
does the Guttmacher Institute.
So those are some really goodresources to look at what's
permissible in your state andhow.
And so more and morepharmacists are getting involved
in this, but whether or notyou're in a state where you have
prescriptive authority, or ifyou are but you're just not
(09:05):
there yet, opil is stillsomething that you can offer as
a solution for your patientsthat is over the counter.
And then I wanted to touch onemergency contraception too,
because most pharmacies willhave Plan B or the generic,
which is levonorgesterol, andthen in some states pharmacists
can also prescribe Ella or theUlipristal, so there's also some
(09:27):
prescribing or some stocking ofthat medication as well.
Speaker 1 (09:32):
And I think it's a great point right here, since
you brought it up.
It's a good segue to talk aboutthe fact that the OTC birth
control pill is different thanthe emergency contraceptive care
.
You're correct.
Let's just make sure that thatis laid out on the table, that
those are different.
Speaker 2 (09:47):
Absolutely.
O-pil is a take it every day,just like you would think of any
of your prescribed progestinonlys.
It's take it every day at thesame time, every day.
That's really important.
And actually, if you look atthe drug facts labels on Opil,
they have that part highlighted.
So it's highlighted in yellowand it says take at the same
time every day.
That's so important.
(10:08):
And then, yes, as we know, withemergency contraceptive options
, you want to take it as soon aspossible after the unprotected
sexual intercourse.
But that's a one time and onlyafter unprotected sexual
intercourse, whereas with opilit's every day.
Speaker 1 (10:24):
Yeah, so back to my loaded question.
So back to my loaded question.
I think what I was getting atwas, at the very least, what
pharmacists should be doing inthis space is providing
education, being accessible forconsultations, assessing
eligibility.
Again, some people may haveconfusion on do I need the?
I just had an unwanted, youknow, potential scare.
(10:46):
Do I get on the O-pill or do Ineed the emergency care first,
you know?
So I think that sort of thing,understanding the difference
between those and being able toprovide the right education and
the right counseling.
And then, yes, if you haveother opportunities in your
state, please check your scopeof practice and expand upon that
.
But I think in general, at thevery least, all pharmacists
(11:08):
should be in the know aboutthese products so that they can
provide proper education, assesseligibility accurately and just
support that patient's journey,whether it be needed for
long-term or emergency orwhatnot.
So, yeah, I'm glad I presentedit as a loaded question first,
because that allowed you to godown that pathway of scope of
(11:29):
crisis.
So that was good.
Let's continue to talk aboutthe opportunities that exist for
pharmacists and for pharmacyteams in general, because this,
being an OTC product, you knowit could very well be that
questions are asked of otherstaff members first, and so they
need to know maybe certainanswers that they can provide
and then when to pass thatreferral on to the pharmacist
for additional assistance.
(11:50):
So, but let's talk about how,increasing the access to
contraception, how is that goingto affect the underserved
population?
Are we, are we going to solveall the problems or are we still
going to have some problems?
Speaker 2 (12:02):
I don't think we can solve all of them.
So, first off, over-the-counterbirth control is really
accessible.
It means that somebody can comein as long as a pharmacy stocks
it.
That's key.
So as long as your pharmacystocks it, then you're providing
this accessible option.
But we still have to realizethat there are going to be
patients who live in areas thathave pharmacies that may or may
not stock it or, if they chooseto stock it, have it kind of
(12:24):
behind the counter, like wetalked about earlier.
So those are someconsiderations.
So kind of behind the counter,like we talked about earlier.
So those are someconsiderations.
So is it actually accessible inan area for the patient where
the patient can get to apharmacy where they can access
this?
What's really nice aboutover-the-counter is they can
decide at last minute I want totry this, or I want to pick this
up, or when they have thataccess.
They don't have to wait for anappointment, which we know in
(12:45):
certain areas, appointment waittimes to establish with a new
provider can be really long.
One thing that I did want tobring up, though, is that OPIL,
at this time, is not routinelycovered by insurance, so even
for patients with insuranceoptions, this would still be an
out-of-pocket cash expense.
One month of OPIL runs around$20 and then three months is
(13:07):
around $50.
It might be a little bitdifferent place to place, but
that's like a ballpark cost, andso we do know.
For some folks the access ofbeing able to actually find it
somewhere might be great, butthe financial access might be a
barrier.
Opil does have a costassistance program, so it is a
program that patients can applyfor to help cover part of the
(13:28):
cost of OPIL.
But even going through thatprocess doesn't allow for them
to immediately get OPIL.
So there's some considerationsthere.
So it's still, you know, agreat resource, a great thing to
know about and look into,especially if you have a lot of
patients who might have thatneed.
Even having to utilize aprogram like that does not
necessarily provide the patientwith that instantaneous access
(13:49):
to Opal as they would have ifthey were able to afford it and
buy it right away, right off thepharmacy.
Speaker 1 (13:54):
Yeah, so again, we've certainly increased access to
the product, but there are stillsome limitations that we have
to consider, and so we can'tjust assume that we stock it.
It's out front, anybody andeverybody can grab it.
There could still be someissues that we're facing.
Yeah, there are probably somelisteners.
I would be remiss if I didn'tsay, if I were listening and
(14:16):
hadn't done my research on someof this, I would be in the same
boat where it's like I'm alittle hesitant, I don't know if
I know enough about what kindof questions are going to come
at me.
What do I need to be doing tofully assess and ensure that the
patient is eligible?
So what are the educationpoints?
What do we need to know as apharmacist, to make sure that
we're saying yes?
(14:36):
You, if they ask yes, youshould pick that up and take it
Totally fine for you to do.
Like, what should you be asking?
Speaker 2 (14:43):
Absolutely so.
If you have a patient come upto you at the counter and
they're like, can I take this?
Here are the things that Iwould ask.
Perfect One I would ask if theyhave any thoughts that they may
be pregnant or are currentlypregnant.
If they are currently pregnantor think that they may be
pregnant, I'm going to advisethem to hold off until they can
be certain that they are notpregnant.
(15:04):
Now, when you're prescribing,there's a couple extra steps you
have to go through in moststates to determine that a
patient is reasonably notpregnant.
But that's not necessarily thecase with an over-the-counter,
so you can use your bestclinical judgment with that.
But if the patient tells you,no, I don't think I'm pregnant,
then you can go with that and wedon't need to say show proof of
(15:24):
that or show me yourover-the-counter use, so use
your clinical judgment there.
The next thing to consider isasking them if they're currently
on any other form of hormonalcontraception.
So you know, they might have anIUD and think that they need to
take this as well, and so wewant to clear up that, if they
are using any other form ofhormonal contraception, that
(15:46):
they do not want to use Opil ontop of that.
So this is in case they'reusing nothing, or if they're
wanting, you know, maybe they'reusing condoms but they want to
use something else, so they cancontinue to use condoms, and
we'd actually recommend them tocontinue to use condoms while
they use over-the-counter birthcontrol.
The reason for that is becausewe know that hormonal
contraceptive options do not doanything for reducing your risk
(16:09):
of STIs, but condoms do.
So that is the big counselingpoint with why you would even if
you're using a hormonalcontraceptive method, you would
still want to recommend condomuse.
And then the other one is ifthe patient has ever had or has
breast cancer, they cannot useO-Pill, and these are also laid
out very clearly inpatient-friendly language on the
drug facts label on.
(16:29):
OPIL.
So if patients don't ask youthis, they should get that
information from the box.
But those are the three thingsthat I want to make absolutely
sure of before I recommend thatsomebody were to use OPIL.
Speaker 1 (16:40):
Yeah, no, that's great One of the things so you
mentioned and I think it's agreat call out to remind
patients, if you have thisopportunity to have the
conversations with them, ifthey're asking questions about
the.
Hormonal contraception does notprotect against STIs.
It is important to also utilizecondoms, but if the main
take-home too, isn't there atransition period where they
(17:03):
must use condoms or else it'snot effective, right?
Speaker 2 (17:07):
They start using Opil .
They want to use condoms forthe next two days or 48 hours.
I usually like to say the 48hours, so we're clear on what
that two-day window is beforeOpil is at its like peak
efficacy, if you will.
So at least for those two days,yeah.
Speaker 1 (17:22):
OK, that's what I wanted to clarify for sure,
obviously we would, we wouldrecommend and encourage to
utilize condoms, you know always, but making sure that they
understand that in order for itto be effective, at least 48
hours, in order for it to beeffective at least 48 hours,
okay, perfect, yes, what aresome of the side effects that we
would need to know about orcounsel on for the OTC pill?
(17:44):
What are some of the thingsthat, if someone says, what's it
gonna do to me?
What information would we needor want to provide?
Speaker 2 (17:52):
Yeah, the most common side effects which, for our
listeners, are going to be verysimilar to any other progestin
only birth control method.
The biggest things that we wouldwant to warn them about is
irregular bleeding, so theymight have some spotting in
between their periods that theydon't normally experience, and
that's pretty common, as you getused to any form of hormonal
(18:13):
contraceptives, but especially aprogestin only as well as they
could experience headaches,dizziness, nausea, increased
appetites, sometimes abdominalpain, cramps and bloating, and
so these are the ones that areactually also notated on that
drug facts label.
So something I also like to dojust as a sidebar, is I like to
(18:34):
point to where I'm getting thisinformation from when I'm
talking to patients, so thatthey know where to refer to if
they forget one of the thingsthat I said so those are the
biggest ones, I will say.
There's also a warning on thereand it does say, if your
headaches are worse, to contacta doctor because they might
recommend that you stop usingO-pills.
So that is on there as well andI know that's something that
(18:55):
I've talked to patients aboutwith other forms of hormonal
contraceptives.
Speaker 1 (18:58):
Sure.
So, kate, going back to thosecommon side effects, are any of
those what I like to call ratelimiting Like, are any of those
where, if you get this, otherthan the headache that you just
mentioned, or is it just arecommendation of be on the
lookout for these things?
You might, you might noticethem, sort of things?
Speaker 2 (19:15):
Mostly a lookout.
But things like the irregularbleeding, like if you're
bleeding continuously or it'svery heavy, that's something
you'd want to contact like anOBGYN or PCP for.
Another thing is abdominal pain, like if this is, you know,
surpassing, like the cramps thatsome folks experience, that's
(19:36):
something you'd also want tocontact a provider about.
And then, yes, the headaches ifthey get really, really bad,
you'll want to escalate that.
Speaker 1 (19:45):
Yeah, for sure.
And then remind us again of thecontraindications for this.
Speaker 2 (19:48):
As far as like if a patient is thinks they may be
pregnant, if they've have or hadbreast cancer, and then as well
as if they're already using aform of hormonal birth control.
Speaker 1 (20:00):
Got it Okay?
Yep, and I think that last oneis really what I wanted to
reiterate because, like you said, sometimes there's confusion,
or I mean, if they're, if theylike me, they forget about
things.
I've had to think back and if Iwere in that case, I'd probably
have to remember if I have anIUD or you know, like so I
wonder, you can have for years,yeah exactly so like it's very
(20:23):
possible that you forget or youknow, you think that you should
be doing both things, orwhatever.
Speaker 2 (20:28):
Yes.
Or there could also be thisthought that like oh, there's
this over-the-counter.
So if I take two forms, like Iwill be double protected and
actually that just increasesyour risks for a lot of this
stuff.
Speaker 1 (20:40):
So we don't want to do that at all.
Yep, okay, perfect.
So then what are?
I know we talked about it'svery state specific and it's on
the listener to make sure thatthey're digging into the state
requirements so that they candetermine whether or not they
can expand care.
But you briefly mentioned thatyou are in that space and that
you do offer expanded pharmacyservices.
(21:01):
Can you talk a little bit aboutwhat does that look like?
That's different than what wejust talked about, where you
know, asking these certainquestions, checking for
contraindications, counseling onside effects, like what takes
it a step further other than thefact that you're actually
prescribing something.
Speaker 2 (21:21):
Yeah, so with over-the-counter conversation
it's really casual.
You know the big things.
We're checking for thosecontraindications first.
We are going over still goingover side effects and what to
expect, and you know that.
You know 48 hour window ofstill needing to utilize condoms
, and so it's a lot of the samecounseling.
It's just a much more informalfashion but I'm doing the actual
appointments.
So we do accept walk-ins.
We encourage folks to callahead because it just helps us
(21:44):
prepare a little bit.
But if someone walks in and wecan accommodate them, we
absolutely will, and so that's amore formal process because I
have them fill out a full intakeform.
So there's differentregulations that we need to make
sure that we check for a coupledifferent things when based on
our statewide protocol that wecomplete this you know intake
form and that we also checkblood pressure.
(22:05):
That's another importantdistinction, because for a lot
of estrogen containing birthcontrol products, we need to
make sure that a patient's bloodpressure is within a certain
range, so that's a big thing.
That is different with actuallyprescribing the method, and
then you know, we're lookingover their intake forms, looking
at their blood pressure,looking at there's a couple
different medications that caninteract with estrogen
(22:27):
containing products specifically, and so looking at some of
those and using the CDC has anMEC medical eligibility criteria
document.
That is really helpful, and sowe're bound by there's four
levels, and four is like themost risky, if you will, so
we're able to prescribe anythingthat falls into like a one or
two, which are less risky areas.
(22:48):
So like, for example, anestrogen containing product with
a patient who has migraineswith aura is a four.
So we cannot prescribe anestrogen containing product for
a patient who states that theyhave migraines with aura, and so
there's just a lot morequestionnaire things yeah.
Questionnaires parts, but thenthe.
You know, as far as identifyingthe product and the counseling
(23:10):
that part is, once we identifythe best product for them and
their preferences, thecounseling part is pretty
similar.
Speaker 1 (23:15):
Yeah, and I want to go back and reiterate that, the
blood pressure control, just tomake sure listeners understand
that's not an issue with the OTCbirth control, because it
doesn't have the estrogencomponent.
Speaker 2 (23:28):
Yeah, the estrogen components are what we want to
watch blood pressure withclosely.
However, Opil is aprogestin-only product and that
is not something that we need tobe concerned about.
Speaker 1 (23:38):
So if a patient were to ask I've heard in the past
that you can't have high bloodpressure or whatever.
If we're talking about the OTCpill, that's not really.
I mean, obviously, if they havehigh blood pressure, we want to
get that under control.
That's a different conversation.
Speaker 2 (23:51):
Yeah, well, that's a whole other intervention, Whole
other intervention yeah.
Speaker 1 (24:01):
Concerns with a progestin-only pill.
No, we don't have those.
Got it Okay.
All right, that's great, Okay.
So in our last few minutes Iwant to just talk about some of
those challenges.
So when you've had theseconversations with patients
about the OTC option, have theyhad any concerns or
misconceptions that you want tobring to light so that we're not
blindsided by those two in ourpractice settings?
Speaker 2 (24:17):
I think the biggest one is the one we already spoke
to is just that differencebetween using levonorgestrel so
emergency contraception and sothe fact that this is not a new
form of emergency contraception,which is what most patients are
pretty familiar with being overthe counter as far as a birth
control option, and that it istruly a once every day
preventative.
So I think making sure thatthat's clear the cost has been a
(24:40):
concern for a few people, andthen also, yeah, that's a pill
every day and that same time isgoing to be important.
We do know.
Like our combined products, youhave a little bit more leeway
on what time of day you take it,but with the progestin only is
you really want it to be thesame time every day.
So, like I said, it'shighlighted on the box.
(25:01):
It's one of the things Idefinitely choose to reiterate
when I'm talking about it, and Ithink that those are probably
the biggest things that, atleast in my experience, I've run
into.
Speaker 1 (25:09):
Yeah, okay, and I loved your recommendation of
actually pointing to thosesections on the box I think you
know again showing them, I'm notjust making this up like it
says right here that you knowthis is these are the potential
side effects.
It says right here you know youcan't be on other birth control
, you can't have had breastcancer, whatever.
So I love that, that practice.
Speaker 2 (25:29):
And then they can refer back to it.
And I know I'm personally notan auditory learner, I'm a
visual learner, so being able tosee that as someone's telling
the same things to me, it'ssuper helpful.
Yeah, so yeah.
Speaker 1 (25:42):
And kudos to them for putting that in the packaging
that way.
I think that's really important, so it's very patient friendly.
Speaker 2 (25:49):
If you haven't seen the box, it's cute, like it has
a really like colorful design,it's like very, it's like a
playful design, if you will.
So I think it's reallypatient-friendly in just the
color scheme as well as thewording on the drug facts label.
So I do think that thatpositions it well for
over-the-counter use and for usto help navigate questions.
Speaker 1 (26:11):
Yeah, that's great.
Well, Kate, is there anythingelse that we didn't cover that
you want to be sure that weshared with our learners for
today?
Speaker 2 (26:19):
I think we covered everything.
The big things about Excel andexpanding scope.
Speaker 1 (26:23):
So yeah, no, that's great.
Well, as I always do, I like tocircle back at the end.
I think it's pretty obviouswhat the game changer is here,
but just summarize again for ourlisteners what's the game
changer here?
But just summarize again forour listeners what's the game
changer here?
Is the game changer the factthat it exists or the fact that
we have that responsibility?
I want your opinion Like whatdo you think?
(26:45):
The game changer is yeah, yeah.
Speaker 2 (26:47):
Can it be both?
Speaker 1 (26:48):
Sure Can it be let's forget it.
Speaker 2 (26:51):
One it exists and honestly we need to have it.
We need to make sure that it isactually accessible to the
patients in our area.
You know we can't access it ifwe don't have it in our
pharmacies, right, and then withthat, whereas I know I've said
that the drug facts labels doesa really good job of outlining
everything we've talked abouttoday, but we can be creative in
(27:12):
the ways that we make sure ourpatients know that we're still
here for them, for even theirover-the-counter needs, and that
they can ask us those questionsabout new over-the-counters
like Opal and beyond, and we canbe creative with how we make
sure that they know that.
I think some people only thinkthey can ask us questions about
the medications that areprescribed to them, but we
(27:33):
absolutely are here for thoseover-the-counter recommendations
too.
Speaker 1 (27:36):
Yeah.
So I think that goes back to mysomewhat of a challenge, I
guess, to make sure that yoursignage is correct and that your
marketing is accurate and thatyou're trying to relate to the
customer that, just because it'sout here for you to grab, we're
still here, we can still answeryour questions, we're still
your trusted professional.
So, yeah, well, that's great,kate, thanks again for giving us
(28:00):
your time.
It's always a pleasure and, asI always state, time flies, I
guess, when you're having fun.
So our time is up, but thankyou so much for being here.
Speaker 2 (28:08):
Yeah, thanks for having me again.
Speaker 1 (28:09):
I appreciate it.
So if you're a CE Plansubscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at CEimpactcom and, as always,have a great week and keep
learning.
I can't wait to dig intoanother game-changing topic with
you all next week.
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, and, as always, I'm excited about
our conversation today.
Access to birth control isevolving and pharmacists are at
the forefront of expandingcontraceptive care through
over-the-counter options andpharmacy-based services.
In this episode, we'll discussthe role of pharmacists in
(00:25):
guiding patients on OTC birthcontrol, counseling on hormonal
contraception and ensuring safe,informed reproductive
healthcare decisions.
And it's so great to have KateRydell back as one of our guest
experts in this episode.
We had you on gosh, probablyback in the fall, discussing OTC
cough and cold recommendations.
(00:46):
So, kate, thanks for joining usagain.
It's good to have you back.
Speaker 2 (00:49):
Yes, thank you, I'm excited to be here.
Speaker 1 (00:51):
Yeah.
So if you weren't able tolisten to the previous recording
with Kate, I'll give her anopportunity to kind of introduce
herself, talk a little bitabout her practice site, her
role and her passion for today'stopic, and then we'll jump into
content.
Speaker 2 (01:06):
Absolutely.
Thanks, Josh.
My name is Kate Rydell and I ama practicing community
pharmacist.
I practice at an independentcommunity pharmacy in Indiana
and there I actually am able toprescribe hormonal
contraceptives, which we'll talka little bit about in this
podcast, as that is somethingthat pharmacists can do in
Indiana.
And then we do stock Ophil, theOTC birth control.
(01:28):
So those are some of the thingsthat I do there.
I'm also on a grant funded teamfor expanding pharmacy access
to hormonal contraceptives forHoosiers.
It's called the Patch Project.
So I do a lot of work in thisspace and I'm excited to be here
as a guest and talk a littlebit about Ophil today.
Yeah, and I'm excited to behere as a guest and talk a
little bit about Ophel today,yeah.
Speaker 1 (01:44):
So again, thanks for taking time out of your busy
schedule.
Sounds like you have yourplates full, so we appreciate it
very much.
So, kate, you've been herebefore.
You know the drill, so you knowI like to jump right in and get
started on content.
So let's talk about, if you canjust remind us of, I guess, the
inception, the beginning ofbirth control in general, and
(02:07):
then kind of when OTC birthcontrol came on the market and
why that's kind ofrevolutionized some things and
why we need to talk about it.
Speaker 2 (02:15):
Yeah, so we've had some hormonal birth control
options since I don't want tosay the exact year in here, but
kind of the 1960s to 1970s yearin here, but kind of the 1960s
to 1970s and actuallynorgesterol, which is the
synthetic progestin that is inOPIL, the OTC birth control, was
approved for prescription usein 1973.
So that's been around for quitesome time Now.
(02:36):
That shift to us having thatover-the-counter birth control
product which was due to HRPharma actually applying to
change the status of norgesterolfrom prescription only to
over-the-counter use.
And so when I was preparing forthis podcast I looked a little
bit into what does that processactually look like?
And essentially, when you wantto change something from a
prescription-use product only toan over-the-counter-use product
(02:59):
, you have to be able todemonstrate that the product can
be used by consumers safely andeffectively without huge
healthcare professionalintervention, so that you know
the marketing for the medication, the drug fact information
labels that we see on thoseover-the-counter products that
you know.
These are easy enough things formost folks to understand
without having that healthcareprofessional interaction that is
(03:23):
often, often, will always,needed for prescription use
products.
So essentially just meaningthat those drug fact labels are
easy to understand.
And so they got that approvalin July of 2023 from the FDA,
and so we, since then that iswhen we've had our first
over-the-counter progestin onlyhormonal birth control option,
and this is something that Iknow has been in the making and
(03:46):
that ACOG has definitelyrecommended over-the-counter use
to increase access.
So this is super exciting.
Even on the FDA approval letterdescribing this new approval
for Opil nogesterol, they talkedabout how that increase in
access and how that is supercritical.
They talked about how thatincrease in access and how that
(04:07):
is super critical.
I'm actually going to glancehere on that approval.
They said that almost half ofthe 6.1 million pregnancies in
the United States each year areconsidered unintended.
So if we can improve access tobirth control.
We can bring that number downbecause we know that unintended
pregnancies can have been linkedto negative maternal outcomes,
including reduced likelihood ofreceiving early prenatal care
(04:28):
and increased risk of pretermdelivery.
So access to hormonal birthcontrol options can be really
critical for reducing thatunintended pregnancy rate and
also improving maternal outcomes.
Speaker 1 (04:40):
Yeah.
So the impact of this movingover the counter is just is is
even greater than just the factof oh, now it's easy for anyone
to have access to it.
Like it just yeah.
Speaker 2 (04:50):
So yeah, so much further than that.
Speaker 1 (04:52):
Yeah, that reach is just so great.
So one thing I would ask thatremind all listeners in case
they don't stock it is thissomething that has to be in a
specific area?
Is it just randomly on a shelf,any shelf of your choice, like
just maybe kind of review thoseparameters there?
Speaker 2 (05:07):
Yeah, absolutely so.
Opil can go anywhere in yourshelf.
I know some pharmacies havechosen to keep it behind the
counter so that folks areprompted to ask pharmacist
questions before getting it, butthat's, honestly, isn't always
recommended.
We want it to be easy accessand out on the shelves in the
pharmacy so.
I know where I work as apharmacist.
We have it with prenatalvitamins, pregnancy tests,
(05:30):
fertility, just other preventionstrategies.
The family planning area is thesection that we have it in,
Although you might, you couldput it in other sections too,
but there's not really anyrestrictions or guidance.
Speaker 1 (05:44):
Okay, yeah, and you know one thing to your point.
I understand why some wouldmaybe want to keep it behind the
counter to make sure thatquestions are being asked and
that they're really guiding.
But, as you mentioned, thatkind of defeats the whole
purpose, because the wholepurpose was to get it over the
counter that maybe there'ssignage that you put near it
(06:11):
that this is a new product.
We'd love to help you answerany questions you have so that
at least it directs them back tothe pharmacy team to ask
questions, absolutely.
Speaker 2 (06:17):
Another thing you could do is our family planning
section is in an area that'sreally easy for me to see from
behind the pharmacy counter.
So if I see somebody spendingsome time over there, it's
really easy for me to go overthere and just ask if they have
any questions or just let themknow.
Hey, if something does come upthat you want to ask me, like I
am here, like I see you.
Also, I do like the idea of thesignage, especially some of our
(06:40):
younger patients.
There's a lot of studies comingout that suggest that some
younger patients don't alwayswant to go ask questions.
So if we can put the signageout that maybe addresses those
questions and kind of think youknow what are the most common
things that my patients aregoing to want to know about this
and have specific signage forthat, we can still answer their
(07:00):
questions without them having tohave that direct conversation
with us.
Another thing is I know a lotof pharmacies, including mine,
have like a patient messagingportal, so that might be another
way that we can encouragepatients to ask us questions.
So a couple of different thingsthat we can utilize to make
sure that we're keeping OPILaccessible but also making sure
(07:23):
that we are readily available inwhatever format patients prefer
to answer questions.
Speaker 1 (07:28):
Those generational differences, those kids of today
love to text.
They don't like to directconversation or face-to-face
even.
Speaker 2 (07:36):
And they text us on our pharmacy system.
Speaker 1 (07:40):
So it can be another great avenue.
Yeah, good call out.
We've kind of talked about therole of hormonal contraception
in general and its inception andwhatnot, but let's just
reiterate pharmacy's expandingrole, the pharmacist's expanding
role in this space.
So, obviously, what should webe doing in the space of
hormonal contraceptive care?
Speaker 2 (07:59):
Oh, that's a loaded question, Josh.
I mean, it kind of depends onwhat state you're in.
Speaker 1 (08:04):
That's fair fair yeah .
Speaker 2 (08:07):
More than 30 states right now have some kind of
legislation that allowsprescribing of hormonal
contraception in some format.
Now it looks different state tostate, so it might be through a
standing order, it might bethrough a statewide protocol.
Some states have utilizedcollaborative practice
agreements to do this, or theyhave a blanket like prescriptive
(08:27):
authority to do this, or theyhave a blanket like prescriptive
authority, and then the methodsthat pharmacists can prescribe
alter state to state.
Most states that have thispermission allow pharmacists to
prescribe the pill, but some canalso do the patch, the ring and
the depo shot.
Speaker 1 (08:40):
Injection yeah.
Speaker 2 (08:41):
So if you're listening to this and you're
like I have no idea what I cando, in my state there's a couple
of references.
So birth control pharmacistkeeps an updated list, and so
does the Guttmacher Institute.
So those are some really goodresources to look at what's
permissible in your state andhow.
And so more and morepharmacists are getting involved
in this, but whether or notyou're in a state where you have
prescriptive authority, or ifyou are but you're just not
(09:05):
there yet, opil is stillsomething that you can offer as
a solution for your patientsthat is over the counter.
And then I wanted to touch onemergency contraception too,
because most pharmacies willhave Plan B or the generic,
which is levonorgesterol, andthen in some states pharmacists
can also prescribe Ella or theUlipristal, so there's also some
(09:27):
prescribing or some stocking ofthat medication as well.
Speaker 1 (09:32):
And I think it's a great point right here, since
you brought it up.
It's a good segue to talk aboutthe fact that the OTC birth
control pill is different thanthe emergency contraceptive care
.
You're correct.
Let's just make sure that thatis laid out on the table, that
those are different.
Speaker 2 (09:47):
Absolutely.
O-pil is a take it every day,just like you would think of any
of your prescribed progestinonlys.
It's take it every day at thesame time, every day.
That's really important.
And actually, if you look atthe drug facts labels on Opil,
they have that part highlighted.
So it's highlighted in yellowand it says take at the same
time every day.
That's so important.
(10:08):
And then, yes, as we know, withemergency contraceptive options
, you want to take it as soon aspossible after the unprotected
sexual intercourse.
But that's a one time and onlyafter unprotected sexual
intercourse, whereas with opilit's every day.
Speaker 1 (10:24):
Yeah, so back to my loaded question.
So back to my loaded question.
I think what I was getting atwas, at the very least, what
pharmacists should be doing inthis space is providing
education, being accessible forconsultations, assessing
eligibility.
Again, some people may haveconfusion on do I need the?
I just had an unwanted, youknow, potential scare.
(10:46):
Do I get on the O-pill or do Ineed the emergency care first,
you know?
So I think that sort of thing,understanding the difference
between those and being able toprovide the right education and
the right counseling.
And then, yes, if you haveother opportunities in your
state, please check your scopeof practice and expand upon that
.
But I think in general, at thevery least, all pharmacists
(11:08):
should be in the know aboutthese products so that they can
provide proper education, assesseligibility accurately and just
support that patient's journey,whether it be needed for
long-term or emergency orwhatnot.
So, yeah, I'm glad I presentedit as a loaded question first,
because that allowed you to godown that pathway of scope of
(11:29):
crisis.
So that was good.
Let's continue to talk aboutthe opportunities that exist for
pharmacists and for pharmacyteams in general, because this,
being an OTC product, you knowit could very well be that
questions are asked of otherstaff members first, and so they
need to know maybe certainanswers that they can provide
and then when to pass thatreferral on to the pharmacist
for additional assistance.
(11:50):
So, but let's talk about how,increasing the access to
contraception, how is that goingto affect the underserved
population?
Are we, are we going to solveall the problems or are we still
going to have some problems?
Speaker 2 (12:02):
I don't think we can solve all of them.
So, first off, over-the-counterbirth control is really
accessible.
It means that somebody can comein as long as a pharmacy stocks
it.
That's key.
So as long as your pharmacystocks it, then you're providing
this accessible option.
But we still have to realizethat there are going to be
patients who live in areas thathave pharmacies that may or may
not stock it or, if they chooseto stock it, have it kind of
(12:24):
behind the counter, like wetalked about earlier.
So those are someconsiderations.
So kind of behind the counter,like we talked about earlier.
So those are someconsiderations.
So is it actually accessible inan area for the patient where
the patient can get to apharmacy where they can access
this?
What's really nice aboutover-the-counter is they can
decide at last minute I want totry this, or I want to pick this
up, or when they have thataccess.
They don't have to wait for anappointment, which we know in
(12:45):
certain areas, appointment waittimes to establish with a new
provider can be really long.
One thing that I did want tobring up, though, is that OPIL,
at this time, is not routinelycovered by insurance, so even
for patients with insuranceoptions, this would still be an
out-of-pocket cash expense.
One month of OPIL runs around$20 and then three months is
(13:07):
around $50.
It might be a little bitdifferent place to place, but
that's like a ballpark cost, andso we do know.
For some folks the access ofbeing able to actually find it
somewhere might be great, butthe financial access might be a
barrier.
Opil does have a costassistance program, so it is a
program that patients can applyfor to help cover part of the
(13:28):
cost of OPIL.
But even going through thatprocess doesn't allow for them
to immediately get OPIL.
So there's some considerationsthere.
So it's still, you know, agreat resource, a great thing to
know about and look into,especially if you have a lot of
patients who might have thatneed.
Even having to utilize aprogram like that does not
necessarily provide the patientwith that instantaneous access
(13:49):
to Opal as they would have ifthey were able to afford it and
buy it right away, right off thepharmacy.
Speaker 1 (13:54):
Yeah, so again, we've certainly increased access to
the product, but there are stillsome limitations that we have
to consider, and so we can'tjust assume that we stock it.
It's out front, anybody andeverybody can grab it.
There could still be someissues that we're facing.
Yeah, there are probably somelisteners.
I would be remiss if I didn'tsay, if I were listening and
(14:16):
hadn't done my research on someof this, I would be in the same
boat where it's like I'm alittle hesitant, I don't know if
I know enough about what kindof questions are going to come
at me.
What do I need to be doing tofully assess and ensure that the
patient is eligible?
So what are the educationpoints?
What do we need to know as apharmacist, to make sure that
we're saying yes?
(14:36):
You, if they ask yes, youshould pick that up and take it
Totally fine for you to do.
Like, what should you be asking?
Speaker 2 (14:43):
Absolutely so.
If you have a patient come upto you at the counter and
they're like, can I take this?
Here are the things that Iwould ask.
Perfect One I would ask if theyhave any thoughts that they may
be pregnant or are currentlypregnant.
If they are currently pregnantor think that they may be
pregnant, I'm going to advisethem to hold off until they can
be certain that they are notpregnant.
(15:04):
Now, when you're prescribing,there's a couple extra steps you
have to go through in moststates to determine that a
patient is reasonably notpregnant.
But that's not necessarily thecase with an over-the-counter,
so you can use your bestclinical judgment with that.
But if the patient tells you,no, I don't think I'm pregnant,
then you can go with that and wedon't need to say show proof of
(15:24):
that or show me yourover-the-counter use, so use
your clinical judgment there.
The next thing to consider isasking them if they're currently
on any other form of hormonalcontraception.
So you know, they might have anIUD and think that they need to
take this as well, and so wewant to clear up that, if they
are using any other form ofhormonal contraception, that
(15:46):
they do not want to use Opil ontop of that.
So this is in case they'reusing nothing, or if they're
wanting, you know, maybe they'reusing condoms but they want to
use something else, so they cancontinue to use condoms, and
we'd actually recommend them tocontinue to use condoms while
they use over-the-counter birthcontrol.
The reason for that is becausewe know that hormonal
contraceptive options do not doanything for reducing your risk
(16:09):
of STIs, but condoms do.
So that is the big counselingpoint with why you would even if
you're using a hormonalcontraceptive method, you would
still want to recommend condomuse.
And then the other one is ifthe patient has ever had or has
breast cancer, they cannot useO-Pill, and these are also laid
out very clearly inpatient-friendly language on the
drug facts label on.
(16:29):
OPIL.
So if patients don't ask youthis, they should get that
information from the box.
But those are the three thingsthat I want to make absolutely
sure of before I recommend thatsomebody were to use OPIL.
Speaker 1 (16:40):
Yeah, no, that's great One of the things so you
mentioned and I think it's agreat call out to remind
patients, if you have thisopportunity to have the
conversations with them, ifthey're asking questions about
the.
Hormonal contraception does notprotect against STIs.
It is important to also utilizecondoms, but if the main
take-home too, isn't there atransition period where they
(17:03):
must use condoms or else it'snot effective, right?
Speaker 2 (17:07):
They start using Opil .
They want to use condoms forthe next two days or 48 hours.
I usually like to say the 48hours, so we're clear on what
that two-day window is beforeOpil is at its like peak
efficacy, if you will.
So at least for those two days,yeah.
Speaker 1 (17:22):
OK, that's what I wanted to clarify for sure,
obviously we would, we wouldrecommend and encourage to
utilize condoms, you know always, but making sure that they
understand that in order for itto be effective, at least 48
hours, in order for it to beeffective at least 48 hours,
okay, perfect, yes, what aresome of the side effects that we
would need to know about orcounsel on for the OTC pill?
(17:44):
What are some of the thingsthat, if someone says, what's it
gonna do to me?
What information would we needor want to provide?
Speaker 2 (17:52):
Yeah, the most common side effects which, for our
listeners, are going to be verysimilar to any other progestin
only birth control method.
The biggest things that we wouldwant to warn them about is
irregular bleeding, so theymight have some spotting in
between their periods that theydon't normally experience, and
that's pretty common, as you getused to any form of hormonal
(18:13):
contraceptives, but especially aprogestin only as well as they
could experience headaches,dizziness, nausea, increased
appetites, sometimes abdominalpain, cramps and bloating, and
so these are the ones that areactually also notated on that
drug facts label.
So something I also like to dojust as a sidebar, is I like to
(18:34):
point to where I'm getting thisinformation from when I'm
talking to patients, so thatthey know where to refer to if
they forget one of the thingsthat I said so those are the
biggest ones, I will say.
There's also a warning on thereand it does say, if your
headaches are worse, to contacta doctor because they might
recommend that you stop usingO-pills.
So that is on there as well andI know that's something that
(18:55):
I've talked to patients aboutwith other forms of hormonal
contraceptives.
Speaker 1 (18:58):
Sure.
So, kate, going back to thosecommon side effects, are any of
those what I like to call ratelimiting Like, are any of those
where, if you get this, otherthan the headache that you just
mentioned, or is it just arecommendation of be on the
lookout for these things?
You might, you might noticethem, sort of things?
Speaker 2 (19:15):
Mostly a lookout.
But things like the irregularbleeding, like if you're
bleeding continuously or it'svery heavy, that's something
you'd want to contact like anOBGYN or PCP for.
Another thing is abdominal pain, like if this is, you know,
surpassing, like the cramps thatsome folks experience, that's
(19:36):
something you'd also want tocontact a provider about.
And then, yes, the headaches ifthey get really, really bad,
you'll want to escalate that.
Speaker 1 (19:45):
Yeah, for sure.
And then remind us again of thecontraindications for this.
Speaker 2 (19:48):
As far as like if a patient is thinks they may be
pregnant, if they've have or hadbreast cancer, and then as well
as if they're already using aform of hormonal birth control.
Speaker 1 (20:00):
Got it Okay?
Yep, and I think that last oneis really what I wanted to
reiterate because, like you said, sometimes there's confusion,
or I mean, if they're, if theylike me, they forget about
things.
I've had to think back and if Iwere in that case, I'd probably
have to remember if I have anIUD or you know, like so I
wonder, you can have for years,yeah exactly so like it's very
(20:23):
possible that you forget or youknow, you think that you should
be doing both things, orwhatever.
Speaker 2 (20:28):
Yes.
Or there could also be thisthought that like oh, there's
this over-the-counter.
So if I take two forms, like Iwill be double protected and
actually that just increasesyour risks for a lot of this
stuff.
Speaker 1 (20:40):
So we don't want to do that at all.
Yep, okay, perfect.
So then what are?
I know we talked about it'svery state specific and it's on
the listener to make sure thatthey're digging into the state
requirements so that they candetermine whether or not they
can expand care.
But you briefly mentioned thatyou are in that space and that
you do offer expanded pharmacyservices.
(21:01):
Can you talk a little bit aboutwhat does that look like?
That's different than what wejust talked about, where you
know, asking these certainquestions, checking for
contraindications, counseling onside effects, like what takes
it a step further other than thefact that you're actually
prescribing something.
Speaker 2 (21:21):
Yeah, so with over-the-counter conversation
it's really casual.
You know the big things.
We're checking for thosecontraindications first.
We are going over still goingover side effects and what to
expect, and you know that.
You know 48 hour window ofstill needing to utilize condoms
, and so it's a lot of the samecounseling.
It's just a much more informalfashion but I'm doing the actual
appointments.
So we do accept walk-ins.
We encourage folks to callahead because it just helps us
(21:44):
prepare a little bit.
But if someone walks in and wecan accommodate them, we
absolutely will, and so that's amore formal process because I
have them fill out a full intakeform.
So there's differentregulations that we need to make
sure that we check for a coupledifferent things when based on
our statewide protocol that wecomplete this you know intake
form and that we also checkblood pressure.
(22:05):
That's another importantdistinction, because for a lot
of estrogen containing birthcontrol products, we need to
make sure that a patient's bloodpressure is within a certain
range, so that's a big thing.
That is different with actuallyprescribing the method, and
then you know, we're lookingover their intake forms, looking
at their blood pressure,looking at there's a couple
different medications that caninteract with estrogen
(22:27):
containing products specifically, and so looking at some of
those and using the CDC has anMEC medical eligibility criteria
document.
That is really helpful, and sowe're bound by there's four
levels, and four is like themost risky, if you will, so
we're able to prescribe anythingthat falls into like a one or
two, which are less risky areas.
(22:48):
So like, for example, anestrogen containing product with
a patient who has migraineswith aura is a four.
So we cannot prescribe anestrogen containing product for
a patient who states that theyhave migraines with aura, and so
there's just a lot morequestionnaire things yeah.
Questionnaires parts, but thenthe.
You know, as far as identifyingthe product and the counseling
(23:10):
that part is, once we identifythe best product for them and
their preferences, thecounseling part is pretty
similar.
Speaker 1 (23:15):
Yeah, and I want to go back and reiterate that, the
blood pressure control, just tomake sure listeners understand
that's not an issue with the OTCbirth control, because it
doesn't have the estrogencomponent.
Speaker 2 (23:28):
Yeah, the estrogen components are what we want to
watch blood pressure withclosely.
However, Opil is aprogestin-only product and that
is not something that we need tobe concerned about.
Speaker 1 (23:38):
So if a patient were to ask I've heard in the past
that you can't have high bloodpressure or whatever.
If we're talking about the OTCpill, that's not really.
I mean, obviously, if they havehigh blood pressure, we want to
get that under control.
That's a different conversation.
Speaker 2 (23:51):
Yeah, well, that's a whole other intervention, Whole
other intervention yeah.
Speaker 1 (24:01):
Concerns with a progestin-only pill.
No, we don't have those.
Got it Okay.
All right, that's great, Okay.
So in our last few minutes Iwant to just talk about some of
those challenges.
So when you've had theseconversations with patients
about the OTC option, have theyhad any concerns or
misconceptions that you want tobring to light so that we're not
blindsided by those two in ourpractice settings?
Speaker 2 (24:17):
I think the biggest one is the one we already spoke
to is just that differencebetween using levonorgestrel so
emergency contraception and sothe fact that this is not a new
form of emergency contraception,which is what most patients are
pretty familiar with being overthe counter as far as a birth
control option, and that it istruly a once every day
preventative.
So I think making sure thatthat's clear the cost has been a
(24:40):
concern for a few people, andthen also, yeah, that's a pill
every day and that same time isgoing to be important.
We do know.
Like our combined products, youhave a little bit more leeway
on what time of day you take it,but with the progestin only is
you really want it to be thesame time every day.
So, like I said, it'shighlighted on the box.
(25:01):
It's one of the things Idefinitely choose to reiterate
when I'm talking about it, and Ithink that those are probably
the biggest things that, atleast in my experience, I've run
into.
Speaker 1 (25:09):
Yeah, okay, and I loved your recommendation of
actually pointing to thosesections on the box I think you
know again showing them, I'm notjust making this up like it
says right here that you knowthis is these are the potential
side effects.
It says right here you know youcan't be on other birth control
, you can't have had breastcancer, whatever.
So I love that, that practice.
Speaker 2 (25:29):
And then they can refer back to it.
And I know I'm personally notan auditory learner, I'm a
visual learner, so being able tosee that as someone's telling
the same things to me, it'ssuper helpful.
Yeah, so yeah.
Speaker 1 (25:42):
And kudos to them for putting that in the packaging
that way.
I think that's really important, so it's very patient friendly.
Speaker 2 (25:49):
If you haven't seen the box, it's cute, like it has
a really like colorful design,it's like very, it's like a
playful design, if you will.
So I think it's reallypatient-friendly in just the
color scheme as well as thewording on the drug facts label.
So I do think that thatpositions it well for
over-the-counter use and for usto help navigate questions.
Speaker 1 (26:11):
Yeah, that's great.
Well, Kate, is there anythingelse that we didn't cover that
you want to be sure that weshared with our learners for
today?
Speaker 2 (26:19):
I think we covered everything.
The big things about Excel andexpanding scope.
Speaker 1 (26:23):
So yeah, no, that's great.
Well, as I always do, I like tocircle back at the end.
I think it's pretty obviouswhat the game changer is here,
but just summarize again for ourlisteners what's the game
changer here?
But just summarize again forour listeners what's the game
changer here?
Is the game changer the factthat it exists or the fact that
we have that responsibility?
I want your opinion Like whatdo you think?
(26:45):
The game changer is yeah, yeah.
Speaker 2 (26:47):
Can it be both?
Speaker 1 (26:48):
Sure Can it be let's forget it.
Speaker 2 (26:51):
One it exists and honestly we need to have it.
We need to make sure that it isactually accessible to the
patients in our area.
You know we can't access it ifwe don't have it in our
pharmacies, right, and then withthat, whereas I know I've said
that the drug facts labels doesa really good job of outlining
everything we've talked abouttoday, but we can be creative in
(27:12):
the ways that we make sure ourpatients know that we're still
here for them, for even theirover-the-counter needs, and that
they can ask us those questionsabout new over-the-counters
like Opal and beyond, and we canbe creative with how we make
sure that they know that.
I think some people only thinkthey can ask us questions about
the medications that areprescribed to them, but we
(27:33):
absolutely are here for thoseover-the-counter recommendations
too.
Speaker 1 (27:36):
Yeah.
So I think that goes back to mysomewhat of a challenge, I
guess, to make sure that yoursignage is correct and that your
marketing is accurate and thatyou're trying to relate to the
customer that, just because it'sout here for you to grab, we're
still here, we can still answeryour questions, we're still
your trusted professional.
So, yeah, well, that's great,kate, thanks again for giving us
(28:00):
your time.
It's always a pleasure and, asI always state, time flies, I
guess, when you're having fun.
So our time is up, but thankyou so much for being here.
Speaker 2 (28:08):
Yeah, thanks for having me again.
Speaker 1 (28:09):
I appreciate it.
So if you're a CE Plansubscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at CEimpactcom and, as always,have a great week and keep
learning.
I can't wait to dig intoanother game-changing topic with
you all next week.
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