6.3 Pharmacist Prescribing of Hormonal Contraception (ORS 689.689)
Key Takeaways
ORS 689.689 lets Oregon pharmacists prescribe and administer injectable contraception (DMPA) and prescribe and dispense pills, patches and rings after Board-approved training.
Under the Oregon contraception protocol, the patient completes an intake form at least every 12 months, and US MEC 2024 Category 3 or 4 findings require referral.
An Oregon pharmacist may accept a self-reported or measured blood pressure. Combined methods need BP under 140/90 and DMPA under 160/100.
Oregon pharmacists may prescribe up to 12 months of contraception, may not require an appointment and must refer if there was no women's health visit within 3 years after the first pharmacist prescription.
Neither ORS 689.689 nor the current Oregon protocol sets a minimum age or requires minors to show a prior prescription.
Why this matters
Oregon was the first state to let pharmacists prescribe hormonal contraception (2015, now ORS 689.689). The law has changed since then. Old study materials describe a requirement that minors show a prior prescription and a ban on self-reported blood pressure. Neither is part of the current statute or Board protocol (v. 06/2025). This section teaches the current rules.
Statutory authority (ORS 689.689)
A pharmacist may prescribe and administer injectable hormonal contraceptives and prescribe and dispense self-administered hormonal contraceptives, following Board rules developed with the Oregon Medical Board, the Nursing Board and OHA and in light of ACOG guidance. The rules must require the pharmacist to:
- Complete a Board-approved training program. The protocol specifies a Board-approved, ACPE-accredited program.
- Provide a self-screening risk assessment tool that the patient completes before prescribing.
- Refer the patient to a primary care or women's health care practitioner upon prescribing.
- Give the patient a written record of the contraceptive and advise consulting a primary care or women's health practitioner.
- Dispense or administer as soon as practicable after issuing the prescription.
The rules must prohibit the pharmacist from:
- Requiring an appointment (an appointment may be offered, not required; OAR 855-115-0335).
- Prescribing to a patient who has no evidence of a clinical visit for women's health within the three years immediately following the pharmacist's initial contraceptive prescription.
Insurance laws on contraceptive coverage apply to pharmacist-prescribed contraceptives (ORS 689.689(3)). Under ORS 743A.066, prescription benefit programs must reimburse a 3-month supply at the first dispensing and a 12-month supply for subsequent dispensings of the same contraceptive.
Methods covered
The protocol covers oral contraceptives (combined and progestin-only), the transdermal patch, the vaginal ring and injectable depot medroxyprogesterone acetate (DMPA), IM or SQ. A pharmacist may administer DMPA. Long-acting reversible methods, such as IUDs and implants, are not covered and require referral.
The protocol care pathway (v. 06/2025)
| Step | Requirement |
|---|---|
| 1. Intake form | The patient completes the Board's Contraception Self-Screening Patient Intake Form, renewed at least every 12 months |
| 2. Exclusion check | Refer if the patient was previously prescribed contraception by a pharmacist and has had no non-pharmacist reproductive or sexual health visit within the 3 years after that first pharmacist prescription |
| 3. Pregnancy screen | If pregnancy cannot reasonably be ruled out, refer |
| 4. Medical and medication history | Apply the 2024 U.S. Medical Eligibility Criteria (US MEC). Any Category 3 or 4 condition or significant interaction for the chosen method means refer (or choose another method that is Category 1–2) |
| 5. Blood pressure | The pharmacist may accept a self-reported BP or measure it. Combined hormonal contraception requires BP under 140/90. DMPA requires BP under 160/100. If above the limit, refer or consider a progestin-only option |
| 6. Prescribe | Up to 12 months of the selected product, dispensed as soon as practicable |
| 7. Counsel | Side effects, starting strategy (quick start with 7 days of backup unless within 5 days of the last menstrual period), adherence, STI prevention, and follow-up (DMPA IM every 11–13 weeks) |
| 8. Visit summary | Give the patient the visit summary, advise a primary care or women's health visit, and notify the provider (within 5 business days under OAR 855-115-0330) |
No minimum age appears in ORS 689.689 or the current protocol. A minor's eligibility follows the same screening pathway.
High-yield US MEC examples
| Condition | Combined (estrogen) methods | Progestin-only pill / DMPA |
|---|---|---|
| Migraine with aura | Category 4: refer or use another method | Category 1–2 |
| Age 35 or older and smoking 15+ cigarettes/day | Category 4 | Category 1 |
| BP at or above 160/100 | Category 4 | DMPA Category 3 (refer); POP Category 2 |
| Current breast cancer | Category 4 | Category 4 |
| History of DVT/PE, not on anticoagulation | Category 3 (lower recurrence risk) or 4 (higher risk) | Category 2 |
The pharmacist must consult the full 2024 US MEC tables (Appendices C and D) for the specific method. The summary chart is a screening aid, not a substitute.
Emergency contraception and condoms
Separate protocols cover emergency contraception and condoms. Levonorgestrel 1.5 mg is also available without a prescription under federal law. A protocol prescription lets the product be billed and documented as a prescription.
Exam scenario
A 17-year-old asks for a combined oral contraceptive. She has never had hormonal contraception and has no women's health visit history. She completes the intake form. Her answers rule out pregnancy and show no US MEC Category 3–4 conditions, and her self-reported BP is 118/76. Under the current statute and protocol, there is no age bar and no prior-prescription requirement, so the pharmacist may prescribe up to a 12-month supply. The pharmacist counsels on backup for 7 days, gives a visit summary, advises a primary care or women's health visit, and notifies any identified provider within five business days. The 3-year clinical-visit rule will matter only if she returns to a pharmacist for contraception later.
Under Oregon's current contraception protocol, which blood pressure practice is acceptable before prescribing a combined hormonal contraceptive?
Only a BP measured by a physician within the past 30 days
Only a BP measured twice by the pharmacist on two separate days
A self-reported BP or a pharmacist-measured BP; combined methods require BP under 140/90 mmHg
No BP assessment is required for patches or rings
A 16-year-old with no prior hormonal contraceptive prescription completes the Board intake form, has no US MEC Category 3–4 conditions and has a normal BP. What may an Oregon pharmacist do?
Prescribe the chosen self-administered contraceptive; current Oregon law sets no minimum age or prior-prescription requirement
Refuse, because patients under 18 must show a prior prescription
Prescribe only with written parental consent
Prescribe only progestin-only pills
A patient first received pharmacist-prescribed contraception in 2022 and has seen no other provider for reproductive or sexual health since. She returns in October 2026 for a new prescription. What does the protocol require?
Prescribe another 12-month supply
Prescribe a 3-month supply and schedule a follow-up
Require an appointment before prescribing
Refer her, because she has had no clinical visit for women's health within the 3 years after the initial pharmacist prescription
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