The Effect of Pharmacist Refusal Clauses on Contraception, Sexually Transmitted Diseases, and Birthrates

Abstract

Emergency contraceptive drugs like Plan B are controversial, and there have been cases within at least 25 states of pharmacists refusing to provide the drug to patients. In response to pressure from activist groups on both sides of the debate, some states passed "Patients' Rights Laws" and other states passed "Pharmacist Rights Laws" dictating pharmacists' legal ability to refuse to fill emergency contraceptive prescriptions. Patients Rights Laws expand access to emergency contraception and protect patients' rights to receive prescribed drugs regardless of pharmacists' personal beliefs. Pharmacist Rights Laws restrict access to emergency contraception and favor pharmacists' rights of refusal. This paper studies substitution behavior among contraception spurred by both policies. I find that both types of laws cause a 7-18\% increase in the prescribing rate of regular birth control pills, and both laws cause decreases in purchases of condoms as well as over-the-counter Plan B. There is not evidence that the policies have effects on rates of sexually transmitted diseases or birthrates on aggregate, however the states that pass the Pharmacist Rights Laws may experience decreases in birthrates for some groups. I find that policies that would be thought to either increase or decrease access to emergency contraception both cause substitution onto the birth control pill, which suggests that the policies may work through an information channel rather than by directly impacting rates of pharmacist refusal.