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United States

After the Roe v. Wade and Doe v. Bolton cases by U.S Supreme Court’s 1973 ruling on abortions nationwide, governments such as federal and state have laws that allow medical professionals and institutes to deny services that pertain to reproductive health without being penalized on financial, professional or legal consequences. The Roe v. Wade case caused a historical survey to be conducted and concluded the “right to privacy” act allowing woman to have parental control over childrearing and the use of contraception for reproductive autonomy. After this woman started to become more informed about contraceptive and requesting them more often than before causing the disruption between pharmacist releasing these medications to patients.

Within the 50 states, almost each one has constructed policies on sterilization, contraceptives and abortion services. In the late 1990s, with the rights being granted from specific policies, dispensing emergency contraceptives on issues of religious and moral objections of providing care has extended from doctors, nurses and hospitals to pharmacist and pharmacies. Furthermore, many states have insurance policies that cover contraceptives if covering other prescription drugs but have an exemption for employers or insurers on religious grounds. Since the late 1990s, broadening access to emergency contraceptives have taken different routes by many state legislatures. In some states where woman have been sexual assaulted it’s mandated to provide them with EC, other states have allowed woman to access EC without a prescription from a physician, another state has limited the ability from pharmacist to deny EC on religious or moral grounds, and in other states it discourages pharmacists from denying to fill contraceptive prescriptions in one states going as far in requiring all pharmacies to stock and fill every method of contraceptives. Nonetheless, other states have pursued the ability to restrict access of EC from state Medicaid family planning eligibility expansions or contraceptive coverage mandates, or by allowing the refusal of providing contraceptive services by pharmacist and some pharmacies.

Under federal law, a provision of the Affordable Care Act of 2010 guarantee coverage of contraceptives apply to most private health plans nationwide. It also specifically required coverage for 18 methods of contraception used by women, related counseling and services, and requires the coverage provided not to be an out-of-pocket cost to the patient. Though in October of 2017, the Trump administration made it easier for employers that offer health care plans to exclude contraceptive coverage. The two regulations that allow employers to reject contraceptive coverage are religious and moral objection, but the courts have blocked the enforcement of these regulations. As of today, 29 states requires that if insurers cover prescription drugs it has to provide FDA- approved prescription contraceptive drugs and devices, 14 states prohibits cost sharing for contraceptives, 10 states prohibit the restriction and delay by insurers or medical management techniques to access contraceptives, 8 states don’t permits the refusal by any employers or insurers but 21 states do allow the refusal to comply with the contraceptive coverage mandate.

Emergency contraceptives are the most common prescription drug denied on religious or moral belief, there have been cases where hormones, drugs and devices used to treat human immunodeficiency virus and diabetic medication have been denied. This topic continues to be fought upon on different levels, the Stormans, Inc v Wiesman case in 2016 is an example of a pharmacy and two pharmacist who held religious objections to EC. They were challenging Washington state regulations on providing all lawfully prescribed pharmaceuticals. Courts have been warned by many professional that if pharmacists are allowed to deny EC prescription on religious or moral belief it can affect public health in many accounts, and could set dangers with respect to “critical, life-saving preventive care”. The court denied the claim stating that all pharmacies even if the owner have religious objection must provide all medication and in this case EC. The pharmacy owner tried to appeal it with the Supreme Court, but was denied leaving the lower court ruling in place. Not many cases go like this, Wal-Mart which is the third largest pharmacy chain refuses to carry EC since 1997, which causes any issue for woman that live in rural areas that may not have another alternative pharmacy nearby.

Reference
Https://www.guttmacher.org/state-policy/explore/refusing-provide-health-services

Https://www.guttmacher.org/state-policy/explore/emergency-contraception

Https://www.guttmacher.org/gpr/2005/08/beyond-issue-pharmacist-refusals-pharmacies-wont-sell-emergency-contraception

Https://www.supremecourt.gov/opinions/15pdf/15-862 2c8f.pdf

Https://www.guttmacher.org/state-policy/explore/insurance-coverage-contraceptives