Pilot pharmacy program gives injections a shot
Women who use Lunelle (Pharmacia Corp., Peapack, NJ) might have more options in getting their monthly contraceptive injections outside clinic walls if a pilot program proves successful. The Easy Access Sites for You (EASY) program developed by Pharmacia Corp. allows druggists at select local pharmacies to administer the monthly shots, once the woman has received her prescription from her health care provider.
"Given our busy lives, having to go to one particular site every month within a window of two to five days can be difficult for a lot of women," says Sharon Schnare,RN, FNP, CNM, MSN, women’s health consultant and clinician with the Seattle King County Health Department in women’s and adolescent health care and the International District Community Health Center in Seattle. "This program is going to be a win-win situation for a lot of people."
Female consumers who go to pharmacy chain stores to do their shopping and take care of their errands will benefit, since they will have access to birth control injections, as well as a host of other services, says Kristin Elliott, Pharmacia Corp. spokeswoman. Pharmacists, who already are offering vaccinations and flu shots, will be able to add another service to their line of care, she notes.
A look at the program
Currently, 30 states allow druggists to administer injections in the pharmacy. (See list, p. 78.)
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Pharmacia Corp. launched the program this spring in participating Seattle pharmacies in the Portland, OR-based Fred Meyer chain of multi-department stores. The participating pharmacies offer a private area where women can receive the injections and ask questions about the method.
The EASY program also is in Walgreen’s in Amarillo, TX, states Elliott. Pharmacia Corp. is talking with other pharmacies in several states, and company officials hope to expand the pilot program, she reports. As more women take advantage of the service, the company anticipates rolling it out nationally later this year, says Elliott.
The cost of the monthly shots, on average, is about the same as a pack of birth control pills: $20-$30, Schnare estimates. Pharmacies participating in the EASY project might charge an additional $10 for the injection, about the same amount billed in a provider’s office, she notes.
There is no need to perform weight checks or measure blood pressure with injection visits.1 The process can be as quick and easy as receiving an allergy shot.
Access aids women
Administering injections is not a new concept for Washington pharmacists, who have been giving immunizations for some time now, says Rod Shafer, RPh, CEO of the Washington State Pharmacists Association in Seattle. The association already offered a training session on injections; it just added a component on Lunelle when the EASY project was launched, he notes.
Many family planners may recognize the Washington state pharmacists’ group from its involvement in the groundbreaking provider/ pharmacist emergency contraceptive (EC) collaborative project. (See Contraceptive Technology Update, June 1998, p. 79, for an overview of the project, which allows pharmacists to prescribe EC under prescriptive authority of health care providers.)
"We, as an association, have very serious concerns in the area of unintended pregnancy and the kinds of costs that it puts on society, not to mention the individuals involved," states Shafer. "We have been very supportive of pharmacists getting involved, including the emergency contraception project, and we feel that this program is just an extension of that, providing ready access to a relatively new form of birth control that should be very useful."
Each dose of Lunelle Monthly Contraceptive Injection contains 25 mg of the progestin medroxy- progesterone acetate and 5 mg of the estrogen estradiol cypionate. The intramuscular injections can only be effective if women receive their injections at the proper times. According to the package insert, Lunelle injections must be given monthly, every 28-30 days and no later than 33 days after the last injection. (A Pocket Guide to Managing Contra-ception [Nelson AL, Hatcher RA, Zieman M, et al. Bridging the Gap Foundation; 2000] advises that patients return in 28 days, plus or minus five days [23-33], for reinjections. Contraceptive Technology Reports [inserted in the March 2001 issue of CTU] advises that subsequent injections should be given within 28-30 days of the preceding injection, although they may be administered as early as 23 days and as late as 33 days.)
Keep eye on window’
Keeping women in the "window" for re-injections is a prime objective for family planning providers. Adding pharmacists to the list of those who can administer the injections expands women’s options, says Schnare.
To help women remember when to receive their Lunelle injections each month, women can register to receive an e-mail reminder notification through the web site www.lunelle.com. Pharmacia Corp. is developing in-store promotional materials for use by participating pharmacies, as well as information for providers to use in counseling women about the EASY project option.
During their training sessions, pharmacists are given information on Lunelle so they may effectively answer women’s questions about the method, says Elliott.
"They become comfortable in knowing what to expect when a woman comes in and what are the commonly asked questions and concerns, so they can be better counselors," Elliott states. "They also find out when they need to go back and involve the provider."
Reference
1. National Association of Nurse Practitioners in Women’s Health. New Option in Hormonal Contraception. Monthly Combination Contraceptive Injection. Web: www.npwh.org/Lunelle/aboutlunelle.htm.
For more information about in-pharmacy Lunelle injections, contact:
• Rod Shafer, RPh, Washington State Pharmacists Association. E-mail: rshafer@u.washington.edu.
For more information on Lunelle, including full prescribing information, visit www.lunelle.com or www.birthcontrolresources.com. Physician and pharmacist information on Lunelle is available by calling (800) 253-8600, extension 38244.
The Washington, DC-based National Association of Nurse Practitioners in Women’s Health is offering a continuing education module on Lunelle in its ongoing New Option in Hormonal Contraception series. The Continuing Education Committee of the National Association of Nurse Practitioners in Women’s Health has approved the activity for 1.8 contact hours, which includes 1.2 contact hours of pharmacology. Visit the association’s web site at www.npwh.org; click on "continuing education."