Highlight
1. Pharmacist-led hormonal contraception prescribing and 12-month dispensing is feasible and effective within the VA healthcare system.
2. Women Veterans expressed high acceptance and satisfaction with the Contraception on Demand (COD) program.
3. Nearly 90% of eligible Veterans opted for 12-month contraceptive supplies, supporting improved continuity of coverage.
4. Clinical pharmacists reported enhanced job satisfaction and reduced burnout related to expanded scope in contraceptive care.
Study Background
Access to consistent and timely contraceptive care is a critical component of reproductive healthcare, yet women Veterans using hormonal contraception within the Department of Veterans Affairs (VA) healthcare system frequently experience breaks in contraceptive coverage. Such gaps can lead to unintended pregnancies, which carry clinical, social, and economic consequences. Traditional contraceptive provision in VA often involves multiple clinic visits, prescription renewal visits, and limited dispensing durations, which pose barriers to continuous coverage.
To address this unmet need, the Contraception on Demand (COD) program was developed. Leveraging clinical pharmacist practitioners (CPPs), a growing and integral part of VA healthcare delivery, COD aims to expand contraceptive access by authorizing pharmacists to prescribe hormonal contraception and dispense up to a 12-month supply to eligible Veterans, aligning with evidence-based recommendations advocating for extended dispensing to reduce discontinuities.
Study Design
This prospective quality improvement project was conducted over seven months, from July 2021 to January 2022, at two VA sites: VA Pittsburgh and VA Puget Sound. The participants included women Veterans seeking hormonal contraception and CPPs trained in contraceptive care.
The intervention consisted of the COD program encompassing:
- Pharmacist provision of hormonal contraception, including new prescriptions and refills.
- Dispensing of up to a 12-month supply of the chosen contraceptive method.
- Identification of candidates for referral for long-acting reversible contraceptives (LARC).
The implementation was evaluated qualitatively and quantitatively through the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), focusing on Veterans’ interest and engagement, clinical effectiveness, patient safety, and staff experiences.
Key Findings
During the study period, pharmacists completed 74 COD visits. Among these visits:
- 57 visits resulted in hormonal contraception prescriptions, including 17 new starts and 40 refills.
- 6 Veterans were referred for LARC placement, demonstrating appropriate triage for expanded contraceptive options.
- A remarkable 90% of eligible Veterans opted to receive a 12-month supply of their contraceptive method, significantly reducing the need for frequent pharmacy visits and potential coverage gaps.
Veterans reported that the COD program was easy to navigate and convenient. Some described it as a superior alternative to their previous experiences obtaining contraception within VA, highlighting reduced wait times and streamlined care.
Pharmacists involved in the program expressed increased job satisfaction, linking the expanded scope of practice to reduced professional burnout, greater clinical engagement, and enhanced team integration.
No safety concerns or adverse events were reported within the study timeframe, supporting the safety of pharmacist-led contraceptive provision.
Expert Commentary
The COD pilot represents an important model of task-sharing in contraceptive care, aligning with broader trends toward leveraging pharmacists in women’s health services to improve access, especially in underserved populations. Previous studies have demonstrated that pharmacist provision of hormonal contraception is both safe and effective, improving access for individuals facing barriers to traditional physician-based care.
Study limitations include its small sample size and restricted geographic scope, limiting generalizability across the entire VA system. Additionally, longer-term outcomes such as sustained contraceptive adherence, pregnancy rates, and cost-effectiveness were not assessed. Future research should incorporate larger multicenter trials with longitudinal follow-up to comprehensively evaluate program impact.
Importantly, the VA’s integrated system is uniquely positioned to adopt such innovative service models. Expansion of pharmacist contraceptive prescribing can reduce care fragmentation, promote interdisciplinary practice, and improve reproductive autonomy for women Veterans.
Conclusion
This pilot confirms the feasibility, acceptability, and preliminary effectiveness of pharmacist-led hormonal contraception prescribing and 12-month dispensing within the VA healthcare system. The COD program effectively addressed gaps in contraceptive coverage, enhanced patient satisfaction, and expanded scope of practice for pharmacists, thereby providing a promising pathway to improving reproductive healthcare access for women Veterans.
Scaling such interventions could significantly reduce unintended pregnancy risk and improve continuity of contraceptive care. Future work should explore scalability, long-term clinical outcomes, provider training frameworks, and potential integration into VA-wide protocols.
Funding and Clinical Trial Registration
This project was conducted as a quality improvement initiative within the VA. No clinical trial registration number is applicable.
References
- Grossman D, Grindlay K, et al. “Hormonal contraception provision by pharmacists: current progress and future directions.” Contraception. 2020;101(1):1-4.
- Reed BD, et al. “Extending hormonal contraception supply to 12 months: evidence and implications.” Obstet Gynecol. 2019;133(2):235-242.
- Chin J, et al. “Pharmacist-led contraceptive prescribing: a systematic review and meta-analysis.” J Clin Pharm Ther. 2022;47(1):123-131.
- Department of Veterans Affairs. VA Women’s Health Services: Improving Access to Contraceptive Options. VA Policy Memo. 2021.
