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Case Studies 3 CALIFORNIA In September 2013, California Governor Jerry Brown signed SB-493 into law. The bill allows self-administered hormonal contraceptives (pills, patches, physician-administered injections and vaginal rings) to be distributed without a doctor’s prescription, only requiring a consultation with the pharmacist, blood pressure test, and completion of a questionnaire (Karlamangla, 2016). Following nearly 3 years of regulatory discussions, the state of California implemented this bill in April of 2016. California’s policy followed similar laws in Oregon and Washington, with proponents of the policies arguing that these laws increase access to birth control and lower the rate of unplanned pregnancies. As Sarah McBane, president of the California Pharmacists Association stated, “The easier it is for someone to access medication, the more likely they are to use it (Karlamangla, 2016)." POLITICS California state Sen. Ed Hernandez (D-West Covina) was the lead sponsor of SB-493. Sen. Hernandez chairs the Senate Committee on Health, and is an optometrist who serves many patients enrolled in Medicaid. Hernandez sponsored a series of scope-of-practice bills, which would empower more healthcare professionals to legally perform healthcare procedures, to address communities with limited access to healthcare. Of this series of bills, SB-493 was the only one to become law. Hernandez started crafting the bill in 2012 with the help of two professional organizations, the California Pharmacists Association (CPhA) and the California Society of Health-System Pharmacists (CSHP) (“The saga of SB 493…” 2014). The American Pharmacists Association summarizes the bill’s legislative history as follows: “On May 29, the California Senate approved SB 493, and it went to the California Assembly. On July 19, the California Medical Association (CMA) became “neutral” on an amended version of SB 493, and soon all organized opposition (primarily from the California Medical Association) was dropped. On September 11, the California Assembly voted unanimously to pass SB 493, and the next day, the state Senate completed final approval. On October 1, Gov. Jerry Brown of California signed SB 493 into law (“The saga of SB 493…” 2014).” While the bill sparked lobbying battles over the roles of doctors and pharmacists in California, critics of the bill focused on one specific unintended consequence: women’s lower likelihood to receive preventative screenings if they no longer have to see a doctor for birth control prescriptions. This concern is supported to some degree by the literature; f. Regardless, Hopkins concludes that rather than hindering access to birth control over-the-counter, there is a need to improve access to preventative screenings for low-income women (Hopkins, 2012). Advocates for SB-493 countered their critics’ opposition by stressing that the law is a step forward as opposed to a “silver bullet” to solve all health problems. Further, they highlighted that there is a lack of a medical connection between birth control and preventive health screenings, and that to hold birth control “hostage” was “paternalistic” (Karlamangla, 2016). In addition to the easier access to birth control, the bill’s supporters point to pharmacists’ ability to improve access to healthcare in areas where there are not enough doctors to meet demand as cause to empower medical providers other than doctors (Mason, 2013).