10.4 Emergency and Hormonal Contraception

10.4 Emergency and Hormonal Contraception

Quick Answer: CGS § 20-633k (P.A. 23-52) lets a trained pharmacist prescribe, in good faith, an emergency contraceptive or a hormonal contraceptive. That is pharmacist prescriptive authority, not “Plan B is OTC so there is nothing to prescribe.” Complete ACPE training, review current CDC U.S. Medical Eligibility Criteria (US MEC), run the DCP screening document, counsel, and notify the named primary-care provider within 24 hours (or give the patient the documentation if no PCP is disclosed). Hormonal supply, including refills, cannot exceed 12 months. Emergency prescriptions get no refills. RCSA § 20-633k-10 forbids IUDs and implants. The statute does not set an age-18 floor.

NABP Competency 2.2 will offer the wrong story: Connecticut pharmacists only sell OTC levonorgestrel. OTC emergency contraception still exists. § 20-633k is the legend-drug prescribing path for emergency contraception (including products that remain prescription) and for ongoing hormonal methods.

What the pharmacist may prescribe — CGS § 20-633k(a)–(b)

Emergency contraceptive means an FDA-approved drug or combination of drugs to prevent pregnancy as soon as possible after unprotected sexual intercourse or a known or suspected contraceptive failure. Hormonal contraceptive means an FDA-approved drug composed of a hormone or combination of hormones to prevent pregnancy, including but not limited to a hormonal contraceptive patch, an intravaginal hormonal contraceptive, or an oral hormonal contraceptive. Prescribe means to order, or designate a remedy or any preparation of, a legend drug for a specific patient.

A pharmacist who satisfies this section and the regulations may prescribe those products in good faith only if all of the following are true:

• The pharmacist completed an ACPE-accredited educational training program that concerns pharmacist prescribing of emergency and hormonal contraceptives, appropriate medical screening, contraindications, drug interactions, treatment strategies and modifications, and when to refer.
• The pharmacist reviewed the most current CDC US MEC (or successor) before prescribing, and if the pharmacist deviates from that guidance, documents the rationale in writing.
• Before dispensing, and at least once per calendar year thereafter for a returning patient, the pharmacist completes the screening document DCP posts on its website, and the pharmacist or pharmacy retains it at least three years. Nothing in that subdivision stops the pharmacist from issuing a hormonal contraceptive for a period not to exceed twelve months, or from requiring more frequent screenings.
• If prescribing is clinically appropriate, the pharmacist (A) counsels the patient about what to monitor and when to seek additional medical attention, and (B) sends notice to any health-care provider the patient identifies as primary care, or, if the patient does not disclose a PCP, provides the patient any relevant documentation.
• The pharmacist gives the patient a document outlining age-appropriate health screenings consistent with CDC recommendations.

No statutory minimum age appears in § 20-633k. Do not invent an 18-and-older rule. Age-appropriate screening content lives on the DCP screening document and in the US MEC. If the screening or treatment algorithm says refer, the pharmacist refers and does not prescribe.

Regulations effective December 27, 2024 — RCSA 20-633k

DCP adopted RCSA §§ 20-633k-1 through 20-633k-10, effective December 27, 2024. They operationalize the statute.

Training (RCSA § 20-633k-2). DCP compiles and posts approved ACPE programs. The curriculum must cover available methods, interviewing, how to use both screening documents, current US MEC, counseling on mechanism, effectiveness, benefits, risks, and directions, contraindications and when referrals are appropriate, method-selection guidelines, side-effect management and referral triggers, recordkeeping, and the prohibited acts in § 20-633k-10. Before a pharmacist prescribes or a technician assists, each must complete an approved program and hold a certificate of completion. That certificate is valid for thirty-six months from the date on the certificate. After it expires, a new approved program and certificate are required. Produce the certificate to DCP on request.

Screening (RCSA § 20-633k-3). The prescribing pharmacist assists the patient in completing the applicable DCP screening document, which includes clinical questions, age-appropriate health-screening information, and a treatment algorithm that states when referral is recommended. A technician who holds a current certificate may, at the pharmacist’s request, (1) provide the document and assist the patient in completing it, (2) take and record blood pressure, and (3) document medical history. The prescribing pharmacist reviews the completed document. Additional counseling information goes on a separate document, not a rewritten screening form.

Hormonal versus emergency (RCSA §§ 20-633k-4 and 20-633k-5):

Records (RCSA § 20-633k-6). Keep completed screening documents in the same manner as the prescription on file, not less than three years after the prescription date. All prescribing records are readily retrievable and produced to DCP not later than 48 hours after a request.

Transfers (RCSA § 20-633k-7). A pharmacy does not need a prescribing pharmacist on staff to accept a transfer of a hormonal-contraceptive prescription, including one written by a prescribing pharmacist. Transfers still follow CGS § 20-616.

Primary-care notice (RCSA § 20-633k-8). Notice to the named PCP is due not later than twenty-four hours after prescribing, unless the patient disclosed no PCP, in which case give the patient the documentation. Confidentiality (RCSA § 20-633k-9) requires reasonable precautions so the patient can complete screening and interview questions confidentially.

Closed list of prohibited acts — RCSA § 20-633k-10

A prescribing pharmacist shall not:

1. Prescribe when the screening document indicates that referral to a practitioner is clinically appropriate.
2. Prescribe without a completed screening document.
3. Issue a prescription for a total supply period greater than twelve months based on the directions for use.
4. Prescribe outside the FDA-approved use in the product’s package insert.
5. Prescribe a medical device, with or without hormones, that is implanted by a practitioner to prevent pregnancy, including intrauterine and implantable devices.

That fifth prohibition is the IUD/implant wall. The statute’s hormonal definition is a drug (patch, ring, and oral are the named examples). Follow the DCP screening and treatment algorithm for which drug products are on the pharmacist pathway. Do not tell the exam an IUD is in scope. Do not invent a “Plan B OTC only” story that erases § 20-633k.

Technician help is not technician prescribing. CGS § 20-633k(c) and RCSA § 20-633k-3(b) limit the trained technician to screening paperwork, blood pressure, and history documentation. The pharmacist still interviews, applies US MEC, decides whether to prescribe, counsels, and notifies.

Realistic Connecticut scenario

A 22-year-old at a Stamford pharmacy asks for “the pill” and has no obstetrician. A pharmacist with a current 36-month certificate screens with the DCP hormonal document, interviews, checks US MEC, measures blood pressure (or a trained technician does that piece), and issues a combined oral contraceptive for twelve months including refills. Notice goes to the internist the patient names within 24 hours. That is § 20-633k, not CDTM and not a physician standing order.

The same patient later wants a copper IUD placed at the pharmacy. RCSA § 20-633k-10(e) forbids implanted devices. Refer.

A 17-year-old requests ulipristal after a broken condom. The statute has no 18+ floor. Complete the emergency screening document, interview, and, if the algorithm supports it, prescribe. No refills on that prescription. Counsel on what to monitor and when to seek care, and handle PCP notice or patient documentation. If the screening document says refer — for example, a condition the algorithm flags — do not prescribe.

A technician who never took the DCP-approved contraception course hands the patient a blank screening form and “starts the birth-control prescription.” That technician is outside § 20-633k(c). OTC levonorgestrel on the shelf does not convert the technician into a prescriber, and it does not excuse the pharmacist from the § 20-633k process when the product being issued is a pharmacist prescription.

Official anchors

• CGS § 20-633k (2025) — pharmacist prescribing of emergency and hormonal contraceptives; training; screening; 12-month hormonal outer limit; technician assistance; three-year records.
• RCSA Title 20, subtitle 20-633k — training (36-month certificate), screening, 12-month/no-refill rules, 24-hour PCP notice, prohibited implanted devices (effective December 27, 2024).
• DCP screening documents and approved-training list — posted on the department website as § 20-633k(b)(3) and RCSA § 20-633k-2(a) require.