On July 25, the House Small Business Committee held a hearing entitled, “Freedom of Conscience for Small Pharmacies.”
Chair Donald Manzullo (R-IL) called the hearing in response to an emergency rule issued by Governor Rod Blagojevich (D-IL) that requires pharmacies in the state to dispense “without delay” all forms of contraception approved by the Food and Drug Administration (FDA), including emergency contraception or the morning-after pill. Expressing his opposition to the rule, he pointed out that “many pharmacies in small communities may not have another pharmacist who can simply fill the prescription for the pharmacist with a moral objection. Nor can they easily transfer the prescription to another pharmacy nearby.” Rep. Manzullo also argued that the rule “will not only violate the pharmacist’s conscience, but may also be extremely costly for business. Pharmacies do not stock every drug that is currently on the market for economic reasons. This rule could become very expensive for pharmacies that are forced to order the morning-after pill when they otherwise would not have.”
Arguing that the topic of the hearing is outside of the committee’s jurisdiction, Ranking Member Nydia Velazquez (D-NY) stated, “I am appalled that we would even hold a hearing on a woman’s right to receive contraception, and as a female Member of Congress, I am even more outraged. This is insensitive to not only the women that sit on this committee, but also to women across the country. Whether or not a small pharmacy in any state chooses to fill prescriptions for birth control is not an issue for this committee to decide upon. It is a women’s rights issue her right to access health care, and her right to live her life as she pleases.” She added, “What is happening today is quite clear. This committee is being used as a tool to push the conservative ideological agenda of one person forward. Nowhere do these protections and rights fall under the jurisdiction of the Small Business Committee.”
Sheila Nix, senior policy advisor to Governor Blagojevich, explained that in February 2005, the Illinois Department of Financial and Professional Regulation received two complaints from a physician’s office alleging that a Chicago-area pharmacy had refused to fill prescriptions for emergency contraception that the office had called in earlier that day. In response to these cases, Governor Blagojevich ordered the department to promulgate a rule “designed to ensure that all Illinois pharmacies dispense prescriptions for contraceptive medication without hassle, without lecture and without delay.” Ms. Nix said that the rule “does not apply to individual pharmacists; it applies to pharmacies. This rule was not intended to nor does it pertain to health care right of conscience legislation or encroach on an individual pharmacist exercising his or her beliefs. Instead, the rule applies to pharmacies, and it directs pharmacies in the business of dispensing contraceptive medication to fill valid, lawful prescriptions for contraception without delay.” She further noted that the rule “applies to only contraceptives and not to RU-486,” adding, “It does apply to all forms of pregnancy prevention, as identified by the FDA. This includes emergency contraceptives, which the FDA found to act in the same way as monthly birth control pills. The National Institutes of Health, the FDA, and the American College of Obstetricians and Gynecologists state that emergency contraception will not terminate a pregnancy.”
President of Fitzgerald and Eggleston Pharmacies Luke Vander Bleek voiced his opposition to the rule, stating, “Professionally, as a pharmacist, I find the published scientific data concerning the actual mechanism of action of emergency contraceptives to be lacking. Therefore, I regard the use of these products by women who are potentially hosting a live human embryo to be unsafe. I find no published evidence for me to conclude that this therapy does not jeopardize a live human embryo…Morally, I regard my involvement in therapies intended to terminate human life to be wrong. Additionally, I believe the Illinois Rights of Conscience Act grants me protection to operate my business as I have in the past.” Mr. Vander Bleek added, “My Governor’s order creates an environment in Illinois whereby a person holding deep moral convictions concerning the unborn cannot own and operate a licensed pharmacy. This environment creates an issue for small business, especially small businesses in rural underserved markets…In an environment where government requires business to be conducted in an amoral manner, the opportunity for moral business owners diminishes, as does the access to services and the economic activity these entrepreneurs may provide.”
The committee heard testimony from Megan Kelly, a married mother in Illinois, who was denied service at a pharmacy in St. Charles when she tried to fill a prescription for emergency contraception and her monthly birth control pills. “As a patient, I consult with my doctor about the best course of treatment,” she stated, adding, “In writing a prescription, my doctor is doing his job and acting in my best interest. I do not expect a pharmacist to breach the relationship I have with my doctor and endanger my health. When pharmacists refuse to dispense medicine, they are not doing their job. Their job is to dispense medication, not moral judgment. A pharmacist’s personal views do not belong in my healthcare.” Ms. Kelly also stated, “As a consumer, I have a right to walk into any pharmacy in America and expect to have my prescription filled without unnecessary delays or discrimination. It is completely unacceptable for this store to refer customers to another provider at a different location.”
Michael Patton, executive director of the Illinois Pharmacists Association, said that the initial impact of the rule “was harrowing for Illinois pharmacists as many of the small, rural communities did not carry emergency contraceptive indication referred to as Plan B,” adding, “These pharmacies did not stock this item because of any personal or religious belief, but rather the simple principles of supply and demand. If there is no demand there is no reason to inventory this product. The reality of these small pharmacies in these remote communities is that if a woman has unprotected sex and determines with the advice of her physician that pregnancy could be imminent, then she will seek out a pharmacy in a nearby metropolitan area to preserve and protect her privacy and anonymity.” He explained that in response to the rule, most small pharmacies “still do not carry [emergency contraception], but have established a relationship for a personal referral with a nearby ‘chain store’ who now will typically stock this product due to the new mandate and the corporate requirement for compliance. The ruling provides for the ability for the pharmacist, with the patient’s permission, to transfer the prescription to a local pharmacy of the patient’s choice or return the prescription to the patient. Unfortunately, what we are now finding is that some individuals are now testing select pharmacies to discern the willingness of the pharmacy to fill their prescription…This has caused concern and fear of many rural pharmacists that they may also be targeted in this ‘plot’ to coerce pharmacies into compliance; thereby creating the need for many pharmacies to now ‘inventory’ this product in the event they might be ‘tested’!”
Mr. Patton suggested that pharmacists who have no moral objection to dispensing emergency contraceptives be trained to dispense the medication “under the formal protocols of a licensed physician” without a prescription: “This would allow pharmacists to be properly trained to counsel and dispense [the medication], and pharmacies to publicly advocate their willingness to dispense emergency contraception without a prescription. This, we feel, addresses the availability of emergency contraception, and also provides the potential for savings as well.”
