San Francisco Chronicle - April 19, 2005
Edward Epstein, eepstein@sfchronicle.com.

Boxer's proposal would require all pharmacies to fill all prescriptions or refer customers to someone who will, despite pharmacists' religious or ethical objections to the nature of the prescription.

The legislation, similar to a proposal in California that two state Senate committees will consider next week, came in response to reports from a dozen states that women have been turned away by pharmacists who wouldn't fill doctors' prescriptions for birth control pills or for "morning-after pills," which are known as emergency contraceptives. In some cases, women say they were also lectured by pharmacists.

California is one of four states considering laws requiring that all prescriptions be filled. Four states permit pharmacists to refuse to fill prescriptions that violate their personal beliefs, and 22 other states are considering similar laws.

On April 1, Illinois Democratic Gov. Rod Blagojevich reacted to a report that a chain store pharmacist had twice rejected prescriptions for morning- after pills by issuing an order requiring that such prescriptions be filled by stores despite an employee's moral or religious objections.

"No delays. No hassles. No lectures," said Blagojevich, who is now being sued by a Christian law center to block his decision.

Boxer, whose bill is similar to legislation proposed by Sen. Frank Lautenberg, D-N.J., and Rep. Carolyn Maloney, D-N.Y., has been a longtime advocate for women's access to birth control and abortion services.

"When people go into their pharmacy with a valid prescription, they should have confidence that their prescription will be filled in a timely manner and they will not face any harassment. Contraceptives are legal and safe, and they help prevent unwanted pregnancies and abortions," she said in introducing her bill.

Boxer's proposal avoids questions about federal jurisdiction by saying any pharmacy that wants to fill Medicare or Medicaid prescriptions has to make sure that all legal prescriptions are filled quickly, even if an individual pharmacist objects. It also says women with prescriptions can't be harassed by objecting druggists. If the prescribed item isn't in stock, the pharmacy would have to order it. But the bill doesn't require pharmacies to stock contraceptives.

Since 1998, the American Pharmacists Association has had in place a "conscience clause" that asserts a pharmacist's right not to fill prescriptions but says pharmacies have the obligation to ensure the patient's access to the drugs. The association supports the California legislation, which is sponsored by state Sen. Deborah Ortiz, D-Sacramento. The association couldn't be reached Monday to see whether it has taken a position on the proposed federal legislation.

However, M. Casey Mattox of the Center for Law and Religious Freedom -- the group affiliated with the Christian Legal Society that sued Blagojevich -- said he objects to the provision in Boxer's bill that forces pharmacists to refer patients to another store to get their prescription filled. "Most pharmacies are comfortable with referring. But that will be too much for some. "

He said Congress should be more concerned with protecting the rights of pharmacists than with those of women who might be inconvenienced by having to go another pharmacy to get their prescriptions filled.

"Congress has an obligation under the 14th Amendment to protect people's constitutional rights. They have an obligation to protect pharmacists' rights, not to violate their rights," Mattox said.

He said the issue has been thrust before legislatures as part of an effort by abortion rights groups to stifle dissent.

"The pro-abortion movement has seized up this as their new issue, basically because their goal is to eliminate any dissent on the question of abortion or even the question of someone's right not to participate in a practice related to abortion," Mattox added.

But Judy Waxman, vice president of health and reproductive rights at the National Women's Law Center in Washington, said the reports her group has investigated showed that pharmacists who object to filling prescriptions "are trying to obstruct people from getting their prescriptions, and a lecture often goes with the refusal."

She said proposals like Boxer's respect druggists' rights. "It's not like we're saying you have to violate your conscience. These bills put the requirement on pharmacies, not pharmacists," Waxman said.

Ortiz said allowing pharmacists to go unchallenged in refusing to fill contraceptive prescriptions could have much broader and serious implications. "Does a doctor get to not prescribe Viagra for a single man or AIDS medicine to a gay man because he objects to the gay lifestyle? We have to define procedures to provide access," she said.

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