Pharmacist prescriptive authority for hormonal contraceptives has expanded significantly over the past decade, with most states now allowing some form of pharmacist-initiated dispensing.
Three models of authority
Independent authority: Pharmacists can dispense after a brief patient assessment with no prior prescription or CPA required. California, Colorado, New Mexico, and others operate under this model.
Standing order: A physician or health department issues a standing order that pharmacists operate under.
Collaborative Practice Agreement (CPA): Pharmacists must have an agreement with a prescriber. More restrictive and creates access barriers in areas without willing prescribers.
States with independent authority
California, Colorado, Hawaii, Maryland, New Mexico, Oregon, Tennessee, Utah, and Virginia allow pharmacists to initiate hormonal contraceptives under protocol without a prescriber relationship. Requirements include a patient assessment, ACOG screening checklist, and appropriate documentation.
California SB 815 (effective July 2026)
California’s SB 815 expanded pharmacist prescribing authority for PrEP, PEP, and naloxone to no longer require a CPA — building on existing hormonal contraceptive authority. This is the most expansive pharmacist prescriptive authority in the country.
What pharmacists should document
Regardless of state model, pharmacists initiating hormonal contraceptives should document: patient assessment findings, contraindications screening, medication dispensed, patient counseling provided, and any referral recommendations. Always verify current requirements with your state board.