NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6954
SPONSOR: Paulin (MS) TITLE OF BILL: An act to amend the education law, the insurance law
and the public health law, in relation to providing for dispensing emer-
gency contraception under certain conditions
PURPOSE OR GENERAL IDEA OF BILL:
This legislation will help to reduce the number of unintended pregnan-
cies by increasing access to emergency contraception for women in New
York State.
SUMMARY OF SPECIFIC PROVISIONS:
Section one provides that this act shall be cited as the "unintended
pregnancy prevention act."
Section two describes legislative findings.
Section three amends subdivision six of section 6527 of the education
law and provides that a licensed physician may prescribe and order a
non-patient specific regimen to a registered professional nurse for
emergency contraception, to be administered to or dispense to be self-
administered by the patient. Section three also provides that a licensed
physician may prescribe and order a non-patient specific regimen to a
licensed pharmacist, for dispensing emergency contraception, to be self-
administered by the patient.
Section four amends subdivision three of section 6807 of the education
law by adding licensed midwife to the list of practitioners who may
prescribe or order a non-patient specific regimen which allows a pharma-
cist to dispense drugs and devices to a registered professional nurse
who may possess and administer such drugs and devices. Current law only
allows a licensed physician or certified nurse practitioner to prescribe
and order a non-patient specific regimen. A new subdivision four is also
added to section 6807 of the education law and provides that a licensed
pharmacist may dispense a non-patient specific regimen of emergency
contraception, to be self-administered by the patient, which was
prescribed or ordered by a licensed physician, certified nurse practi-
tioner, or licensed midwife.
Section five amends the education law by adding a new section 6829:
emergency contraception; non-patient specific prescription or order.
Subdivision one defines the terms "emergency contraception" and "pres-
criber." Subdivision two provides that section 6629 of the education law
applies to the administering or dispensing of emergency contraception by
a registered professional nurse or licensed pharmacist pursuant to a
prescription or non-patient specific regimen made by prescribers as
outlined in three sections of the education law. Subdivision three
provides that the administering or dispensing of emergency contraception
by a registered professional nurse or licensed pharmacist shall be done
in accordance with professional standards of practice and in accordance
with written procedures and protocols.
Subdivision four outlines the contents of written material that must be
provided to the patient. Such written material shall be developed or
approved by the commissioner in consultation with the Department of
Health (DOH) and the American College of Obstetricians and Gynecologists
(AC00).
Section six amends paragraphs (a) and (b) of subdivision four of section
6909 of the education law. Paragraph (a) provides that emergency contra-
ception is added to the list for which a certified nurse practitioner
may already prescribe and order a non-patient specific regimen to a
registered professional nurse. Paragraph (b) provides that, in addition
to a registered professional nurse, a certified nurse practitioner may
also prescribe or order a non-patient specific regimen to a licensed
pharmacist, for dispensing emergency contraception.
Section seven amends subdivision five of section 6909 of the education
law by adding a licensed midwife to those practitioners who may already
prescribe and order a non-patient specific regimen to a registered
professional nurse.
Section eight amends section 6951 of the education law by adding a new
subdivision four which provides that a licensed midwife may prescribe
and order a non-patient specific regimen to: a registered professional
nurse for emergency contraception to be administered to or dispensed to
be self-administered by the patient and; a licensed pharmacist for
dispensing emergency contraception, to be self-administered by the
patient.
Sections nine, ten, and eleven amend three sections of the insurance law
to mandate that under these articles any insurance policy that covers
emergency contraception shall also cover emergency contraception when
provided by a non-patient-specific prescription.
Section twelve adds a new paragraph (g) to subdivision one of section
207 of the public health law to broaden the education and outreach
program to include information on emergency contraception and its safe-
ty, efficacy, appropriate use and availability.
Section thirteen provides that this act shall take effect on the 180'h
day after it shall have become law, provided that the commissioner of
education is authorized to promulgate any and all rules and regulations
and take any other measures necessary to implement this act.
JUSTIFICATION:
EC is Safe: In February of 1997, the Food and Drug Administration (FDA)
announced that certain combinations of estrogen and progestin were safe
and effective for use as post-coital emergency contraception. Adminis-
tered in pill form, EC is a higher dosage of standard birth control
pills that serve to prevent pregnancy after unprotected intercourse,
including when birth control fails or in cases of sexual assault. EC can
reduce the risk of pregnancy from 75% to 89% if the first dose is taken
within 72 hours of unprotected intercourse. EC is almost seven times
more effective if taken within the first 24 hours of unprotected inter-
course. EC will not cause an abortion; it is not the same as RU-486(also
known as Mifepristone or the medical abortion pill). In 1999, the FDA
prescription use Plan B (which is Levonorgestrel, a form of progester-
one) is, currently, the only brand of emergency contraception packaged
for that use. In 2007, Plan B was approved by the FDA for over the coun-
ter sale for individuals of seventeen years of age or older. In 2013 the
age restriction was lifted and women of all ages can now purchase Plan B
without prescription. Nevertheless, young women in New York State are
still facing some barriers to access EC, as the prescription mandate for
women younger than seventeen years of age is still in effect for other
brands of EC. This bill would allow New York State pharmacists and
registered professional nurses to dispense EC from a non-patient specif-
ic order, written by either a licensed physician, certified nurse prac-
titioner or licensed midwife, bypassing the frequent difficulties
encountered in obtaining medical appointments at offices with limited
hours, long waits, or inconvenient locations. By accessing EC in this
manner, young women will have the opportunity to ask questions and have
them answered by a healthcare professional who will also provide a fact
sheet and a verbal explanation about EC. Currently, a pharmacist may
refuse to dispense any medication if he or she reasonably feels that it
would endanger someone. This same discretion would apply to EC.
EC Will Significantly Lower the Number of Abortions: In New York State,
there were 120,349 induced abortions in 2002, of which 9,155 were
performed on girls ages seventeen and under, according to the New York
State Department of Health (NYSDOH). Medical experts, including the
American College of Obstetricians and Gynecologists (ACOG), believe that
increased access to EC will reduce the number of abortions in New York
by at least one half. Increased access to EC will not only reduce the
number of abortions young women have, but reduce the cost and health
risks associated with pregnancy, childbirth and abortion. A commonsense,
risk-benefit analysis indicates that increased access to EC will enable
young women to pursue a better, healthier future by preventing an unin-
tended pregnancy in a safe and timely fashion.
EC Will Positively Impact the Lives of Young Women: Victims of sexual
assault are most often younger women and adolescents. According to
Tjaden and Thoennes, researchers from the National Institute of Justice,
"Rape is primarily a crime against youth." A study conducted by National
Violence Against Women reported 5495 of rape victims were between the
ages of 12 and 17. Similarly, the National Women's Study found that 62%
of sexual assault victims were under seventeen years of age. Every two
years, Youth Risk Behavior Survey (YRBS) conducts a study of high school
students in grades nine through twelve throughout the entire country. In
1997 and in 1999, a question was added to the Massachusetts survey
regarding teen violence. One in five girls reported being sexually or
physically abused by a dating partner and of those females, one in ten
was sexually abused. The statistics support the fact that there is a
tremendous need for prevention of unintended pregnancies in very young
women. A misconception about EC is that by giving women, especially
young women, access to EC the rate of sexually transmitted infections
(STIs) will increase and it will lead to more risky sexual behavior.
However, a study providing EC to 2,117 young women ages 15 to 24,
reported in the January 5, 2005 issue of the Journal of the American
Medical Association (JAMA), concludes that giving young women access to
BC does not negate the ability of women to act responsibly. The study
confirmed that EC does not increase promiscuity or unprotected sex among
women, nor does it cause women to abandon their regular birth control
methods. Moreover, other methods of birth control such as condoms and VI
spermicides may already be purchased over the counter in pharmacies,
grocery stores, or convenience stores.
EC Will Be Covered by Insurance: This legislation provides that if an
insurance policy covers contraception when it is provided pursuant to a
prescription, that same policy shall cover emergency contraception.
Education and Outreach Programs are Effective: In 1998, Washington State
began to conduct public relations and promotional activities to increase
public awareness of emergency contraception and of the national emergen-
cy contraception hotline (1-888-NOT-2-LATE). Calls from Washington State
to the hotline increased tenfold, an average of 1,160 per month, after
the campaign was launched, indicating that outreach programs are effec-
tive. This legislation adds emergency contraception to the list of
health related issues for which the Commissioner of Health shall conduct
education and outreach programs. Making the public aware of the safety,
efficacy, appropriate use, and availability of EC is important to the
health and safety of women in New York.
Conclusion: EC is designed to be just that: emergency contraception, to
be used when other methods of contraception fail or in cases of rape,
incest, or human error. Many pregnancies, births and abortions are far
more dangerous to a woman's health, especially a young woman's health,
than EC. By allowing women the chance to prevent an unintended pregnan-
cy, the abortion rate will drop, healthcare costs will decrease and
young women will not have to start their adult lives with the difficult
decision of whether to have a baby (often as a single mother), have an
abortion, or give a baby up for adoption. By allowing young women
access to EC, they will have the opportunity to have a healthier and
more promising future.
PRIOR LEGISLATIVE HISTORY:
A.420A, 2014 referred to health. Same as S.1494A, referred to higher
education.
A.420, 2013 referred to ways and means. Same as 5.1494, referred to
higher education.
A.85, 2011 and 2012 advanced to assembly calendar 436. Same as 5.892,
referred to rules.
A.627A, 2010 advanced to assembly rules calendar 125. Same as S.1410A.
referred to higher education.
A.627, 2009 advanced to assembly calendar 351.
A.5569A, 2007 and 2008 passed assembly. Same as S.3579A, 2007 and 2008
referred to higher education. Similar bills introduced between 2002 and
2006 are listed here:
A.9906, 2006 passed assembly. Same as S.6686, 2006 referred to higher
education.
A.116, 2005 passed assembly. Same as S.3661, 2005 passed senate.
Vetoed, memo 47.
A.888, 2003 and 2004 passed assembly. Same as S.3339, 2003 and 2004
referred to higher education.
A.9653A, 2002 referred to health.
FISCAL IMPLICATIONS:
None,
EFFECTIVE DATE:
This act shall take effect 180 days after it becomes law provided the
commissioner of education is authorized to promulgate any and all rules,
regulations and measures necessary for implementation on or before such
date.
