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Case Studies 8 Most adolescents are excluded from the policy: only patients over the age of 18 and emancipated minors are eligible. The bill prohibits pharmacists from requiring appointments for the provision or dispension of the drug. The bill also permits pharmacies to charge patients an administrative fee, but if the patient has an insurance plan that covers oral contraceptives they can only be charged their applicable copay. Therefore, while pharmacists can charge the annual administrative fee, the fee cannot become the burden of insured patients. Further, pharmacies must disclose the “total cost” of hormonal contraceptives provided to patients over the counter to patients when requested. COSTS “In 2010, 56% of all pregnancies in Tennessee were unintended” (Kost, 2015). At this time, the federal and state government spent $530.7 million on unintended pregnancies in Tennessee, $130.7 million of which was paid for by the state (Sonfield and Kost, 2015). The legislature is hopeful that the law will decrease the number of unintended pregnancies, and therefore Medicaid costs. CONCERNS The biggest concern in Tennessee regarding over the counter birth control sales was whether oral contraceptives are safe to use without a doctor's approval. However, supporters, which include the American Congress of Obstetricians and Gynecologists, argued there are more dangerous medicines available over the counter. Other concerns include paying for over the counter medications. However, if the oral contraceptives were prescribed by a pharmacist, they would be covered by insurance just as they would be from a physician. Also, there was concern that women may not go in to get annual or every other year screenings. However, a study out of the University of Texas found that approximately 80% of women utilizing over the counter birth control would still continue to receive preventive screenings (Hopkins, 2012). There was also a concern that women may lie on their self-assessment screening, and that the self-assessment may be the only thing pharmacists have to judge whether or not a woman is safely able to be prescribed birth control. While it is true that people are not always truthful, the bill’s sponsor responded that it “is not possible to mandate clairvoyance.” There was also a concern that the bill gives too much discretion to the pharmacist and does not explicitly say that pharmacists have the authority reject giving high risk women a prescription. Also, there was the concern that the bill does not give immunity to pharmacists, so they may be at risk of litigation.