Concise Consult Facilitating dialogue between healthcare professionals and patients

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1 Concise Consult Facilitating dialogue between healthcare professionals and patients Oral Contraceptives: An Overview for Prescribing Pharmacists For Pharmacists Summary of state-specific legislation allowing pharmacists to prescribe contraceptive products Guide to the different types of oral contraceptives For Your Patients Tear pad with answers to frequently asked questions about birth control pills

2 EVOLVING ACCESS TO CONTRACEPTION Access to prescription contraception has evolved recently in the United States, thanks in part to the Affordable Care Act (ACA), 1 which requires most health plans to cover some types of birth control at no cost to patients 2 Notably, the ACA mandate has saved approximately $255 per year for the average user of birth control pills and has reduced women s annual overall out-of-pocket spending on oral contraceptives (OCs) by $1.4 billion 3 In California and Oregon, access to birth control has evolved even further as the result of legislation allowing qualified retail pharmacists in those states to prescribe and dispense certain methods of contraception 4,5 In both states, a female patient who visits a specially trained pharmacist to obtain prescription birth control will be required to complete a self-screening risk assessment tool, which helps determine medical eligibility for one or more contraceptive products Legislation regarding pharmacist-prescribed contraception is also being considered in other states

3 STATE GUIDANCE FOR PHARMACISTS California In California, a qualified retail pharmacist may prescribe and dispense an OC, transdermal contraceptive patch, vaginal contraceptive ring, or contraceptive injection to female patients (no age restrictions) 4,6 To become qualified, pharmacists will need to complete California State Board of Pharmacy-approved Continuing Education that covers the administration of hormonal contraception in accordance with the current United States Medical Eligibility Criteria for Contraceptive Use and other relevant guidance from the Centers for Disease Control and Prevention 6-9 Oregon For the most current information about relevant state requirements, please visit pharmacy.ca.gov/licensees/hormonal_contraception.shtml or call the California State Board of Pharmacy ( ). In Oregon, a qualified retail pharmacist now has the authority to prescribe and dispense OCs or the transdermal contraceptive patch to 5 Female patients 18 years of age and older Female patients younger than 18 years, as long as they had previously received a prescription for birth control from a primary care provider or a women s healthcare professional To become qualified, pharmacists will need to complete a training program that is approved by the Oregon State Board of Pharmacy and is related to prescribing birth control pills and patches 5 For more information about that training program, visit If a female patient is younger than 18 years and has never received a prescription for birth control, she will need to obtain her first prescription from a primary care provider or women s healthcare professional, rather than a pharmacist 5 Pharmacists can help by encouraging the patient to schedule a clinical visit For a downloadable list of clinics in Oregon that offer free or low-cost family planning services, please visit ClinicListRegions1-6Combined.pdf For the most current information about Oregon state requirements, please contact the Oregon State Board of Pharmacy via (pharmacy.board@state.or.us) or phone ( ). You may also visit Before prescribing any contraceptive, please read the product s full Prescribing Information.

4 DISCUSSING OPTIONS WITH PATIENTS WHO REQUEST ORAL CONTRACEPTION If you are a retail pharmacist in California or Oregon, you may encounter female patients who specifically request a prescription for an OC. Provided that you have completed the requisite qualification process, you should: Conduct a thorough review of her answers to the questions in your state s risk assessment tool and determine whether it is safe to prescribe and dispense an oral contraceptive to her 4-6 Counsel the patient about the hormonal contraceptive options for which she is medically eligible 9 Discuss the importance of using condoms to help prevent HIV infection and other sexually transmitted diseases 9 Refer the patient to a primary care or women s healthcare provider for appropriate follow up 4,5 Many patients who request the pill may not realize that there are several different types of OCs available; please consult with and advise individual patients as needed. OVERVIEW OF DIFFERENT TYPES OF ORAL CONTRACEPTIVES The box below provides an overview of progestin-only and combination OCs. Progestin-Only Oral Contraceptives Also known as mini-pills, progestin-only OCs are a possible option for women who should not take estrogen. Combination Oral Contraceptives A combination OC regimen includes active tablets that contain both estrogen and progestin. In a monophasic combination OC regimen, the doses of estrogen and progestin are the same in all of the active tablets. Also may include inert tablets (placebo) In a multiphasic combination OC regimen, the doses of estrogen and progestin in the active tablets may vary. Also may include tablets that contain inert ingredients or unopposed estrogen An extended-cycle combination OC regimen includes 84 active tablets that contain a fixed dose of estrogen and progestin and 7 days of either placebo or unopposed estrogen. Intended to limit the occurrence of withdrawal bleeds to 4 times a year A continuous-cycle combination OC regimen contains 28 days of a fixed dose of estrogen and progestin without a hormone-free break. Intended to help women avoid menses altogether Sources: Centers for Disease Control and Prevention, MMWR ; Sech et al., Merck Manual Teva Generics offers an extensive line of OCs. Product-specific details and resources for prescribing OCs are available at BirthControlForMe.com/professional.

5 For Patients Birth Control Pills: Frequently Asked Questions Now that my pharmacist can prescribe birth control pills to me, should I still schedule appointments with my usual healthcare provider? Yes, you are encouraged to continue seeing a primary care provider or women s healthcare provider for routine examinations, regardless of who has prescribed birth control to you.* How much can I expect to pay out of pocket for birth control pills? That depends on your insurance coverage. In many cases, birth control pills are available at no cost to patients. 1 Ask your pharmacist about your options. Can you give me some helpful tips for taking the pill? Your birth control pill should be taken at the same time every day. Try combining pill-taking with a daily task, such as making coffee or brushing your teeth, or setting alerts on your cell phone. Take the pills in the order directed on your pill dispenser. Make sure you have enough pills on hand, especially if a holiday is coming up and/or you will be away from home. Can I become pregnant if I forget to take my pills? Yes. Do not skip taking a pill, even if you do not have sex often. Will the pill protect me from HIV and other sexually transmitted infections? No. Male and female condoms are the only birth control products that can help protect you from HIV infection (AIDS) and other sexually transmitted infections. What if I m not happy with the pill I m taking? If you are not happy with the pill you are taking, please speak with your healthcare provider about other birth control pill options. *As of May 2016, California and Oregon allow pharmacists to prescribe contraception. This may change as other states consider similar legislation. Teva Generics is proud to lead the way in empowering you to own your health. In fact, in the United States, 1 of every 3 prescriptions for a birth control pill is filled with a Teva Generics product. Talk with your healthcare provider today to find out which pill might be best for you. For resources empowering you to make the best birth control choice and to view the extensive line of birth control pills offered by Teva Generics, please visit BirthControlForMe.com. REFERENCE: 1. United States Department of Labor, Employee Benefits Security Administration. FAQs About Affordable Care Act Implementation (Part XXVI). May Accessed August 8, Teva Pharmaceuticals USA, Inc. All rights reserved. November 2016 TG Haymarket Media, Inc. Ver la versión en español en la página siguiente.

6 Para Pacientes Píldoras Anticonceptivas: Preguntas Frecuentes Ahora que mi farmacéutico me puede recetar píldoras anticonceptivas, aun así debo programar una cita con mi proveedor de atención médica habitual? Sí, se le recomienda que continúe viendo a su proveedor de atención primaria o proveedor de atención médica para mujeres a fin de realizarse exámenes de rutina, independientemente de quién le haya recetado el antinconceptivo.* Cuánto puedo esperar pagar de mi bolsillo para las píldoras anticonceptivas? Eso depende de la cobertura de su seguro. En muchos casos, las píldoras anticonceptivas están disponibles sin costo para las pacientes. 1 Pregunte a su farmacéutico sus opciones. Me puede dar algunos consejos útiles para tomar la píldora? Debe tomar la píldora anticonceptiva a la misma hora todos los días. Intente combinar la hora para tomar la píldora con una tarea diaria, como hacer café o cepillarse los dientes, o poner la alarma en su teléfono celular. Tome las píldoras como se indica en su dispensador de píldoras. Asegúrese de tener suficientes píldoras a mano, especialmente, si se acercan las vacaciones o va a estar fuera de casa. Puedo quedar embarazada si olvido tomarme las píldoras? Sí. No deje de tomar las píldoras, incluso si no tiene relaciones sexuales con frecuencia. Me protegerán las píldoras del VIH y otras infecciones de transmisión sexual? No. Los condones masculinos y femeninos son los únicos productos anticonceptivos que la pueden ayudar a protegerse de la infección por VIH (SIDA) y otras infecciones de transmisión sexual. Qué sucede si no estoy satisfecha con las píldoras que tomo? Si no está satisfecha con las píldoras que toma, hable con su proveedor de atención médica sobre otras opciones de píldoras anticonceptivas. * A partir de mayo de 2016, California y Oregón permitirán a los farmacéuticos recetar medicamentos anticonceptivos. Esto puede cambiar a medida que otros estados consideren aplicar legislaciones similares. Teva Generics se enorgullece de ser líder para ayudarla a que se empodere y sea dueña de su salud. De hecho, en los Estados Unidos, 1 de cada 3 recetas para píldoras anticonceptivas que se despachan es un producto Teva Generics. Hable con su proveedor de atención médica hoy mismo para averiguar qué píldora podría ser la más adecuada para usted. Para obtener recursos que la empoderen para tomar la mejor decisión en cuanto a la anticoncepción y ver la amplia línea de píldoras anticonceptivas que ofrece Teva Generics, visite BirthControlForMe.com. REFERENCIAS: 1. Administración de Seguridad de Beneficios de los Empleados del Departamento de Trabajo de los Estados Unidos. FAQs About Affordable Care Act Implementation (Part XXVI) (Preguntas frecuentes sobre la implementación de la Ley de Cuidado de Salud de Bajo Precio [Parte XXVI]). Mayo de Fecha de acceso: 8 de agosto de Teva Pharmaceuticals USA, Inc. Todos los derechos reservados. Noviembre de 2016 TG Haymarket Media, Inc. See English on previous page.

7 TEVA GENERICS Teva Generics is proud to lead the way in empowering women to own their health. We offer an extensive line of OCs. In fact, 1 of every 3 OC prescriptions filled in the United States is a Teva Generics product. Product-specific details and resources for prescribing OCs are available at BirthControlForMe.com/professional. REFERENCES 1. US Centers for Medicare & Medicaid Services. Read the Affordable Care Act. where-can-i-read-the-affordable-care-act/. Accessed August 2, United States Department of Labor, Employee Benefits Security Administration. FAQs About Affordable Care Act Implementation (Part XXVI). May Accessed August 2, Becker NV, Polsky D. Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing. Health Affairs. 2015;34(7): California Legislative Information. Senate Bill No xhtml?bill_id= sb493. Accessed August 2, Oregon Laws 2015, Chapter 649, HB orLaw0649.pdf. Accessed August 2, California State Board of Pharmacy, Department of Consumer Affairs. Order of Adoption: Protocol for Pharmacists Furnishing Self-Administered Hormonal Contraception. California Code of Regulations Title 16, Division 17, Article 5, Accessed August 2, California State Board of Pharmacy Lawbook for Pharmacy. lawbook.pdf. Accessed August 2, Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, MMWR. 2016;65(RR-3): Centers for Disease Control and Prevention. U.S. Selected Practice Recommendations for Contraceptive Use, MMWR. 2016;65(RR-4): Sech L, Segall-Gutierrez P, Silverstein E, et al. Oral contraceptives. Merck Manual (Professional Version). June oral_contraceptives.html#v Accessed August 2, Teva Pharmaceuticals USA, Inc. All rights reserved. November 2016 TG This MPR Concise Consult is produced as a basic reminder of important information for healthcare professionals. Readers are advised to consult manufacturers and specialists if questions arise about specific products, treatments, or diseases. The publisher and editors do not assume liability for any errors or omissions. MPR and MPR Concise Consult are registered trademarks of Haymarket Media, Inc Haymarket Media, Inc.

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