The Sexist

Bitter Pill: How the District’s Pharmacies Fail Women


In the District, Pharmacists: Rubber. Women: Glue.

For most professionals, an acceptable excuse is required to miss work: a swollen appendix, ailing grandmother, whiplash, at the very least.

Pharmacists, on the other hand, may refuse to do their jobs for any old reason—or for none at all. We're talking about birth control, of course. In the District, for example, pharmacists are not required to provide such products, especially if their "personal views" won't allow it. According to NARAL Pro-Choice America, only six states bar pharmacists from withholding birth control prescriptions/doing their jobs: California, Illinois, Maine, Nevada, New Jersey, and Washington.

That means that D.C. is a hotbed of the ultimate bullshit defense for denying health care to women. Pharmacists here can refuse to provide women's health care based on such "personal views" as latent sexism, unsubstantiated medical opinion, or whim. Some other "personal views" local pharmacies have offered up:

It's private. A pharmacy's trust factor often relies on its adherence to privacy—its hushed consultations, the 3-foot courtesy bubble between customers, pills wrapped in nondescript white paper packaging. For contraception allies, these conventions help keep birth control a personal transaction not subject to political interference. But right across the counter, the "privacy" excuse allows pharmacists to deny you access to contraception at any time while shirking explanation and accountability-no questions asked. A flack for Wellington Pharmacy defers to the privacy excuse—"it's a relationship between a person and their physician"—as to why the pharmacy, affiliated with Catholic-leaning Providence Hospital, provides Viagra but no birth control.

This pharmacy is here to deny your rights.
Those not interested in providing medications to humans can choose from a host of careers that are not involved in providing medications to humans. And yet, the D.C. area is home to several anti-contraception advocates that insist upon going the pharmaceutical route. For all these pharmacies gets wrong about women's health-namely, their positions on condoms, birth control, and the morning-after pill-they often get one thing right: At the most fanatical anti-contraception outfits, women at least know what they're not getting. America's latest pro-life pharmaceutical poster child, Chantilly's Divine Mercy Care Pharmacy, defied the tight-lipped industry standard with its grand opening last fall. Holy water slicked the shelves. A bishop blessed the operation. The AP took video. But though the DMC is the only local pharmacy affiliated with anti-contraception group Pharmacists for Life International, it's less dangerous than the other area pharmacies quietly denying access to birth control.

They've got inventory issues. On a recent Saturday, I contacted 10 local CVS pharmacies to see if they had the morning-after pill in stock. Nine did. The pharmacist at the one that didn't informed me that his store's Plan B shipments arrived on Tuesdays, so I would just have to wait 72 hours to get my hands on the pill. Never mind that the effectiveness of Plan B decreases with each hour after unprotected sex, and that after 72 hours, its chances of preventing pregnancy are kaput. The representative at another CVS that did have the pill informed me they only had two pill packs left on the shelf. They, too, received new shipments only once a week, on Tuesdays, so my chances of getting the morning after pill depend on a guessing game of how many condoms broke in the District of Columbia in any given week. Here's a tip, CVS shoppers: If you're going to need to use the morning-after pill, just make sure that morning falls on a Wednesday.

They're weirdos. Though it's not uncommon for pharmacists to operate behind a shield of privacy, some display a distaste for discussing women's health that borders on good old-fashioned sexism. When it comes to contraception, pharmacists are often skittish about discussing the most basic aspect of their business—which prescriptions they will fill and which they will not. And it's not just pharmacies with moral motivations against contraception that aren't talking. In a telephone interview, the proprietor at Dupont's Tschiffely Pharmacy refused to discuss whether the shop dispensed the morning-after pill. But when I stopped in to try to pick up a pill pack, Plan B was in stock and offered with a smile. Georgetown's Dumbarton Pharmacy, meanwhile, declined to discuss its contraceptive options at all. Playing coy with contraceptive options is less cute when women need to locate them instantly in order for them to work. No other common, FDA-approved, over-the-counter medication would receive such silent treatment from pharmacists.

Even chain stores like Rite Aid and CVS, which have national policies that adhere to the contraception-access requirement of the six aforementioned states, must draft elaborate plans by which to protect their pharmacists' idiosyncrasies. Sometimes, those quirks mean losing business. Take Rite Aid's policy, which outlines a three-step plan by which a pharmacist can avoid personally filling your birth control prescription: 1) Have another technician fill the prescription; 2) if there is no other technician on hand, contact the closest Rite Aid to dispense the medication, then have the prescription delivered back to the customer's preferred Rite Aid location; 3) if no other local Rite Aid pharmacist will consent to dispensing birth control, locate the nearest competitor that will fill the customer's need, then follow through until that need is met.

They don't trust you—or your doctor. Cathedral Pharmacy owner Paul Beringer, a Catholic, will not provide the morning-after pill. "I consider it abortion," he says. Non-emergency contraception is dispensed on a case-by-case basis-meaning that the pharmacist can nullify the decision of your medical doctor because he thinks a prescription might be faked, is uncomfortable dispensing contraception to women under the age of 18, or otherwise wishes to impose his "personal views" on your body.

They fear your vagina. Target Pharmacy provides prescription birth control as well as the morning-after pill. Other women's health products, however, aren't available even with a doctor's signature.

Parker, 27, who declined to give her full name, came to the pharmacy straight from work with a prescription from her gynecologist's office. It was 5:30 p.m. and raining, and she needed to fill the prescription that evening in order to prep for a procedure scheduled for the next morning.

But Target's pharmacist refused to fill the prescription because the doctor instructed that the pill was to be inserted vaginally. Parker's doctor had prescribed her Cytotec, an FDA-approved treatment for ulcers. The medication is also routinely prescribed off-label to dilate the cervix to induce labor in pregnant women, or, in Parker's case, to aid in the insertion of an IUD. Parker-who wasn't pregnant-learned later that the medication can also be used to induce abortion.

The pharmacist, who did not give her name, says she rebuffed Parker's prescription because she disagreed with the doctor's insistence on vaginal insertion."That's not how it's supposed to be prescribed," she says. "It's supposed to be taken orally."

The pharmacist says she tried to call Parker's doctor's office but wasn't able to reach anyone at the late hour. Parker says the pharmacist never picked up the phone while she was there and that she had to beg her to consult her doctor before she got an explanation-that the office would be closed and there was nothing she could do.

Parker left the pharmacy in tears. "I got a little hysterical," she says. "I couldn't believe that this pharmacist, who has less training than my doctor, would deny me this medication that I needed, because it was specified that it went in the vagina?"

After asking for the name of a supervisor, Parker took solace in Columbia Heights' other chain pharmacy. Still red-eyed, she crossed the street to the CVS. There, "a very nice, flirtatious Latino man filled my prescription, no questions asked."

Photo by Darrow Montgomery.

  • SteveRO

    Totally non-sensical article. 1 CVS store out of 10 doesnn't have a single produce and that is suddenly newsworthy? Pharmacists are "weirdos" because they aren't willing to discuss their business practices with a reporter for a free newspaper looking to write a hit piece? A pharmicist dares to call a doctor to verify an off-lable prescription and is now part of some vast conspiracy to deny women their rights?

    Wow. This may be one of the worst thigs the City Paper has published in a long, long time.

  • http://www.washingtoncitypaper.com/blogs/sexist Amanda Hess

    Hey SteveRO. I've reviewed many local pharmacies based on their access to women's health for the paper. If you're interested, you can find them at this tag:

    http://www.washingtoncitypaper.com/blogs/sexist/tag/capitol-pill/

    Some score really well. Some don't (if a pharmacy gets low marks on its access to women's health, I guess that's what passes for a "hit piece").

    I do think that the way a pharmacist discusses women's health---or decides not to discuss it---is important. When I call a pharmacy, and they tell me that they have birth control, then I ask specifically about the morning after pill---and that over-the-counter non-prescribed medicine is for some reason off the table---it gives me pause as to whether that pharmacy supports a woman's right to contraception.

    Women need to take the morning after pill as soon as possible. And that means that they have to know where it is, and when it's there. It's not surprising that a CVS wouldn't have something in stock---it's a little surprising that a pharmacist would tell me I could come back in three days, as if oblivious to the time-sensitivity of the drug.

    I believe the point with the last pharmacist was that she did not call the doctor to verify the prescription.

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  • Anita Amero

    We live in a capitalist society. The pharmacies that don't want to supply what the market demands should fall by the way side. In short ladies (and gentlemen), it's time to organize some boycotts!

  • stacey

    I do feel strongly that more legislation and enforcement is needed for both pharmacists and doctors, both of whom report in large numbers, in anonymous surveys administered by the AMA, that they refuse to discuss or inform patients of medical options that they morally object to, in shocking frequency.

    HOWEVER, this article does nothing to help the situation. 90% of pharmacies reported in the article had the drug in question. The pharmacist who declined to fill a prescription for cytocec WAS following procedure: the FDA has approved the drug for oral use only, and without confirmation from a doctor, it would have been neglectful of the pharmacist to fill the prescription. The patient clearly was able to obtain the prescription elsewhere, and if she couldn't she should have contacted the doctor's after-hours number herself.

    Not all birth control is an emergency; neither is taking a prescription the night before an IUD is inserted.
    This article could have been vastly more effective if it focused on true emergency situations--denial of morning-after prescription-writing for rape victims treated at Catholic hospitals when not given the choice of which treatment facility they are taken to, for example; or pharmacists who refuse to fill prescriptions for rape victims, forcing them to relive their trauma by going pharmacy to pharmacy looking for a professional who can do their job without judging their customer.

  • http://www.washingtoncitypaper.com/blogs/sexist Amanda Hess

    Hey stacey. Thanks for your input on the situation. I'll definitely look into the scenarios you're talking about.

    I have to respectfully disagree that 90 percent of CVS pharmacies having the drug is good enough. CVS has a national policy to provide that contraception and if they can't, they're required to tell you where to get it. The reps I talked to seemed to totally disregard the fact that 72 hours is too long to wait to take the morning after pill.

    But the CVS survey was just one example---this piece was a capstone of a project I've been doing that rates many local pharmacies on their commitment to providing for women's health. CVS is one of the better ones. There are some Catholic pharmacies in there, too. You can find the whole series here:

    http://www.washingtoncitypaper.com/blogs/sexist/tag/capitol-pill/

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