Duke Health patients won’t be able to take advantage of a new provision allowing pharmacists to dispense certain medications without a prescription just yet.
A provision in House Bill 96 allowing pharmacists to dispense oral or transdermal contraceptives, prenatal vitamins, post-exposure prophylaxis for HIV, glucagon for low blood sugar and nicotine replacement therapy without a prescription went into effect Feb. 1. The same bill restricted minors’ access to non-Federal Drug Administration-approved vaccines without parental consent as of August 2021.
The medications would not truly be “over the counter” because pharmacists still have to counsel patients and eventually notify their primary care provider, according to Duke Campus Center pharmacist Ellen Hawk. Additionally, pharmacists cannot dispense the medication without a standing order, which are signed instructions of a provider authorized by state law to prescribe the medication.
After getting a standing order, Duke still has to decide how to implement the policy.
“I don’t know why [the North Carolina General Assembly] said Feb. 1 if things weren’t going to be ready by then,” Hawk said.
There is currently no set timeline for when pharmacists will be able to dispense the medications, according to a written statement from the Duke pharmacy administration department.
“Immunizing pharmacists at Duke Health and across North Carolina are not able to dispense any of the prescription medications covered by HB 96 without a prescription until the State Health Director issues a standing order and corresponding protocols to do so,” the statement read.
Updated standing orders will be issued “as soon as possible,” according to Catie Armstrong, press assistant for the N.C. Department of Health and Human Services office of communications.
“We are collaborating with health professional organizations to ensure the most complete and clinically appropriate orders and protocols are put into place,” Armstrong wrote in an email.
The state pharmacy and medical boards also have to adopt communication standards between pharmacists and primary care providers, according to the pharmacy administration department. Duke Health also has to “develop appropriate internal policies and procedures accordingly to govern use of the authority provided in HB 96.”
Recent media coverage of the bill has focused on its expansion of access to birth control. It’s too early to tell what the impact of expanded access would be at Duke, but Hawk estimates there are about 100 oral contraceptive prescriptions at the Duke Campus Center Pharmacy per week.
Junior Anna Muthalaly, who has researched birth control access in the American South, said that the ability to get birth control without a prescription would be a “game changer.”
“For Duke students specifically, I would say this bill doesn’t change much because you can go to Student Health and ask for a prescription, and unless your parents are looking at an itemized bill they won’t know,” Muthalaly said. “However, my overall opinion as an advocate is that birth control should be available everywhere without a prescription.”
Sophomore Gabrielle Fry, who teaches the house course Condoms and Counseling, expressed a similar sentiment.
“A lot of students run into issues with [birth control] being billed on their insurance,” Fry said. “I think things would be much easier without a prescription.”
Student Health has previously stated that families are not informed about the care students receive but acknowledged certain things may appear on insurance documents.
The bill’s inclusion of post-exposure prophylaxis (PEP), a medication that prevents HIV after a potential exposure, is also a bright spot. In 2014, about 540 out of every 100,000 people in Durham County were living with HIV.
Junior Keenan Powers said access to PEP is a great first step, but that making pre-exposure prophylaxis (PrEP) more accessible on campus would be a “big plus.” PrEP is only available by prescription, and he faced challenges acquiring it.
“The only reason I haven’t [taken PEP] is because I’ve heard from friends the side effects can be very intense, and you have to take the drug every day for a month,” Powers wrote in a message to The Chronicle.
PEP must be started no more than 72 hours after exposure and must be taken for 28 days. In comparison, PrEP can be taken as a daily prescription or via the “2-1-1 method,” in which the user takes two pills before sex, one pill 24 hours later and the final pill 24 hours after that. The latter method is not included in guidelines for use from the Centers for Disease Control and Prevention, but Powers wrote that it helped mitigate side effects.
“While PEP is certainly good to have as an option, I worry it wouldn’t be nearly as effective as PrEP since few students would want to deal with a month of persistent nausea, dizziness and fatigue that comes with more than 25% of cases, especially while they are in school,” Powers wrote.
Additionally, PrEP is legally required to be free or low-cost under most insurance plans. This is not the case for PEP.
Likewise, some have raised concerns about whether drugs dispensed without a prescription will be covered by insurance.
“Who’s going to pay for it?” Fry asked. “The person, or the government, or insurance, or a mix?”
In normal circumstances, under the Student Medical Insurance Plan contraceptives and tobacco cessation are supposed to be free or low-cost while the other drugs included in HB 96 may cost more.
Blue Cross and Blue Shield of North Carolina, which administers SMIP, wrote in a statement that it is “committed to ensuring our members have timely access to safe, effective and affordable prescription medicines” and HB 96 “currently has no impact to coverage, regardless of who prescribes or dispenses the medication.”
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Nadia Bey, Trinity '23, was managing editor for The Chronicle's 117th volume and digital strategy director for Volume 118.