PHARMACY EXECUTIVES BRACE FOR CONTROVERSY OVER PLAN B

Dan Alaimo / Additional reporting: Liza Casabona

Supermarkets have been walking a tightrope amid the high-profile battle over pharmacists who refuse to fill contraceptive prescriptions on moral grounds.

While a number of drug stores and mass merchants have been hit by the media over pharmacists who won't dispense the so-called "morning after" pill, Plan B, from Barr Pharmaceuticals, Woodcliff Lake, N.J., or in the case of Wal-Mart Stores, Bentonville, Ark., a corporate decision not to carry the product, supermarket pharmacy executives have been forestalling the day the controversy lands on their doorstep.

Several leading pharmacy executives interviewed during last month's Supermarket Pharmacy Conference of the Food Marketing Institute, Washington, said their chains have had no problems with pharmacists refusing to dispense such emergency contraceptives. So far, none of the instances cited in media reports have involved supermarket pharmacies, except a Chicago-area Osco drug store owned by Albertsons, Boise, Idaho. Albertsons did not respond to a request for comment.

Most have adopted the policy of the American Pharmacists Association, Washington, which recognizes the right of an individual pharmacist to exercise conscientious refusal, while calling for systems to be put in place to ensure that patients can obtain the prescribed medication.

"We are not in the position of mandating people's morals," said Curtis Hartin, director of pharmacy, Schnuck Markets, St. Louis.

"When people come to work for us, we expect them to honor the prescriptions, because that is the business that we are in. At the same time, we respect people's beliefs, but we want to make sure that if our pharmacists do have some moral obligation not to dispense a particular product, that they at least make an effort to get that patient the prescription that they are looking for," he said.

"We've taken the stance of following the APhA policy," said John Beckner, director of pharmacy and health services, Ukrop's Super Markets, Richmond, Va. "We certainly want to be sensitive to the individual pharmacist's religious beliefs, but also feel like it is very important to take care of patients requesting medication."

Anne Burns, APhA's group director, research and development, said, "We support the right of the pharmacist to step away, but not step in the way of the patient getting their medication."

Such controversies are not new to pharmacy, noted John Fegan, senior vice president, pharmacy, Ahold USA, Braintree, Mass. For example, it was the same when oral contraceptives were first introduced in the 1970s and pharmacists refused to dispense them. "But here we are 30 years later and it has become a routine product to dispense without too much of a problem." Like oral contraceptives, "I think [the furor over Plan B] will settle down eventually, but right now it is controversial," Fegan said.

At present, "we are trying to respect the pharmacists who have the moral issues, but also respect the oath that we took to provide the medication to the consumers who we are filling the prescriptions for. So we are working the issue," he said.

The debate over Plan B has become somewhat nuanced. There is the case of Wal-Mart, which does not carry emergency contraceptives "for business reasons," according to spokeswoman Jacquie Young. She would not specify what those reasons are.

"Since our pharmacists cannot fill these prescriptions, they will refer customers to another pharmacy in the community that can meet their needs in a timely manner -- just as they would do for any other medication that Wal-Mart does not stock," Young said.

However, there are situations where Wal-Mart is the only convenient pharmacy in a rural area. For example, there are 10 towns in Texas where the Wal-Mart has the only pharmacy, according to The Dallas Morning News. Young would not comment on this, except to reiterate, "Wal-Mart does not carry emergency contraceptives."

Responding to political pressure from all sides, there are state and national efforts to legislate the issue. Tennessee and Texas have seen proposals that would protect the jobs of pharmacists who refuse to fill emergency contraceptives, while Illinois and California are considering laws that would force pharmacists to fill such prescriptions.

Meanwhile, Illinois Gov. Rod Blagojevich signed an emergency rule last month requiring pharmacies to fill birth control prescriptions quickly, and California Sen. Barbara Boxer has introduced similar legislation at the national level.

Depending on the state, such laws could conflict with regulations that give pharmacists the right not to fill prescriptions for medical reasons.

For example, there may be drug interactions the physician has not considered, or a patient may have prescriptions for two drugs that do basically the same thing, noted APhA's Burns.

Plan B -- Levonorgestrel, a high-dosage birth control tablet -- has a number of drug interactions and possible side effects, according to Internet sources

"There are a variety of situations where pharmacists would use their judgment to make sure the patient is getting the best use of their medication," Burns said.

APhA is monitoring what is going on at the state level. "There is some concern that if laws are passed that restrict the pharmacist's ability to step away, there could be some unintended consequences," she said.

FMI does not have a position on the controversy, said a spokesman. Barr Pharmaceuticals declined comment. The National Association of Chain Drug Stores, Alexandria, Va., would not comment beyond its position that the issue is better left to retailers than to government.

"The pharmacists have to be able to exercise their professional judgment in what's appropriate or not appropriate for a patient," said Don Clark, director of pharmacy operations, K-VA-T Food Stores, Abingdon, Va. "Unfortunately, there have been some people who have let their moral beliefs get into that decision-making process. While I respect that, I don't know if that is necessarily what a pharmacist should be doing."

Schnucks has 24 stores in Illinois and the emergency rule there "created a lot of difficulty within our group of pharmacists because it requires the pharmacists to dispense a product that may not be in the patient's best interest," Hartin said. "That's counter to the basic premise of pharmacy" to do no harm and not dispense anything that may be harmful.

"That has nothing to do with morality. Taking the practice of pharmacy away from the pharmacist is really no place for government, in my opinion," Hartin said.

California has an existing law regarding emergency contraceptives that requires education on the topic and for pharmacists to send the patient to another pharmacy if they cannot provide the contraception, said Michele Snider, director of pharmacy, Save Mart Supermarkets, Modesto. A new bill in the state Legislature "requires all pharmacists to dispense emergency contraception, no questions asked. That's very, very controversial," she said.

"Our company is of the mind that it's up to the individual pharmacist, and their ethical and moral stance, whether to dispense or not," she said.

"A pharmacist should definitely have a choice," said Verne Mounts, director of pharmacy, Buehler Food Markets, Wooster, Ohio. "If there are moral issues and concerns, we'll figure out a way to work around them."

"We have not seen any resistance within our pharmacies," said Edward Saba, vice president, pharmacy, Bashas', Chandler, Ariz. With all the publicity the issue is getting, Saba planned to survey the chain's pharmacists. "I am going to bring it to the table and see what everybody's feelings are," he said.