,,ii #aaith ,,congress #ast ,session ,s4 #bcjb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #af1 #bjbe ,mr4 ,booker 7for himself1 ,mrs4 ,murray1 ,mrs4 ,shaheen1 ,ms4 ,baldwin1 ,mr4 ,kaine1 ,mr4 ,blumenthal1 ,ms4 ,duckworth1 ,mrs4 ,gillibrand1 ,mr4 ,warner1 ,ms4 ,rosen1 ,mr4 ,whitehouse1 ,mr4 ,heinrich1 ,ms4 ,smith1 ,ms4 ,hirono1 ,mr4 ,schiff1 ,ms4 ,warren1 ,mr4 ,wyden1 ,mr4 ,markey1 ,mr4 ,merkley1 ,mr4 ,van ,hollen1 ,ms4 ,alsobrooks1 and ,mr4 ,padilla7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to establish certain duties for pharmacies to ensure provision of ,food and ,drug ,administration-approved contraception and medication related to contraception1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,access to ,birth ,control ,act4 #b4 ,findings ,congress finds as follows3 7#a7 ,family planning is basic health care4 ,access to contraception helps people determine if and when to become pregnant4 ,contraception is also a cornerstone of reproductive autonomy and can help people fulfill their educational1 professional1 and social aspirations4 7#b7 ,as a result of the enactment of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 approximately #aea1fjj1jjj individuals in the ,united ,states were enrolled in private health insurance plans in the ,united ,states in #bjbj1 including #eh1jjj1jjj women between the ages of #ai and #fd who had coverage of contraceptive methods approved1 cleared1 or authorized by the ,food and ,drug ,administration without cost-sharing under such plans4 7#c7 ,the ,patient ,protection and ,affordable ,care ,act saved women #a1djj1jjj1jjj on birth control pills alone in #bjac4 7#d7 ,according to the ,centers for ,disease ,control and ,prevention1 nearly #b_/c of women between the ages of #ae and #di are currently using a contraceptive method1 and among sexually active women who were not seeking pregnancy1 nearly #i in #aj have used contraception4 7#e7 ,although the ,centers for ,disease ,control and ,prevention included family planning in its published list of the ,ten ,great ,public ,health ,achievements in the #bjth ,century1 people in the ,united ,states face a myriad of barriers in accessing birth control1 including cost1 geography1 immigration status1 language access1 discrimination1 and stigma4 ,these contraceptive barriers are rooted in systemic inequities1 structural racism1 and other forms of oppression in our health care system and society4 7#f7 ,in #bjai1 approximately #b1bic1jjj pregnancies1 nearly #db percent of all pregnancies1 in the ,united ,states were unintended4 7#g7 ,systemic racism and discrimination1 as well as lack of access to comprehensive sex education1 exacerbates severe health inequities and creates additional barriers to accessing contraception2 for example1 due to high uninsured rates and barriers1 ,hispanic women with low-incomes experience a significantly higher rate of unintended pregnancy 7#eh percent7 compared to their ,white counterparts 7#cc percent74 ,in a #bjbc study exploring challenges accessing contraceptive care among people who identified as ,asian ,american1 ,native ,hawaiian1 or ,pacific ,islander1 ,black or ,african ,american1 ,indigenous1 or ,latina_/,latinx1 #de percent of respondents reported experiencing at least one challenge accessing contraception in the past year4 7#h7 ,in addition to preventing pregnancy1 contraceptives are used for a range of medical purposes1 such as treating abnormal uterine bleeding1 irregular menstrual cycles1 and endometriosis1 as well as for people managing other chronic conditions1 which are generally higher in communities of color due to systemic discrimination4 7#i7 ,the ,food and ,drug ,administration has approved1 cleared1 or authorized multiple emergency contraceptive methods as safe and effective in preventing unintended pregnancy and has approved over-the-counter access to some forms of emergency contraception for all individuals1 regardless of age4 ,if taken soon after unprotected sex or primary contraceptive failure1 emergency contraception can significantly reduce a person's chance of unintended pregnancy4 ,additionally1 in #bjbc1 the ,food and ,drug ,administration approved the first over-the-counter daily birth control pill which will give people of all ages greater access to birth control options without a prescription4 7#aj7 ,contraception is a protected fundamental right in the ,united ,states and access to contraception should not be impeded by one individual's personal beliefs4 ,providers1 including pharmacists1 play a key role in providing contraceptive services and important information about prescription and over-the-counter birth control options to people across the country4 ,it is critical that contraceptive care is provided to people of all ages in a supportive way that is culturally appropriate and delivered without stigma1 bias1 or delay4 7#aa7 ,reports of pharmacists refusing to fill prescriptions for contraceptives1 including emergency contraceptives1 or provide emergency contraception over-the-counter have surfaced in ,states across the ,nation1 including ,alabama1 ,arizona1 ,california1 the ,district of ,columbia1 ,georgia1 ,illinois1 ,louisiana1 ,massachusetts1 ,michigan1 ,minnesota1 ,missouri1 ,montana1 ,new ,hampshire1 ,new ,mexico1 ,new ,york1 ,north ,carolina1 ,ohio1 ,oklahoma1 ,oregon1 ,rhode ,island1 ,tennessee1 ,texas1 ,washington1 ,west ,virginia1 and ,wisconsin4 7#ab7 ,since the ,supreme ,court decision in ,dobbs v4 ,jackson ,women's ,health ,organization 7#adb ,s4 ,ct4 #bbbh 7#bjbb771 there have been increased reports of people being denied birth control at pharmacies4 7#ac7 ,in #bjbb1 the ,department of ,health and ,human ,services issued guidance clarifying that refusing to dispense birth control can be sex discrimination under section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf74 #c4 ,duties of pharmacies to ensure provision of contraception and medication related to contraception ,part ,b of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bch et seq47 is amended by adding at the end the following3 #bdi4 ,duties of pharmacies to ensure provision of contraception and medication related to contraception 7a7 ,in ,general ,subject to subsection 7c71 a pharmacy that receives drugs or devices approved1 cleared1 or authorized by the ,food and ,drug ,administration in interstate commerce shall maintain compliance with the following3 7#a7 ,if a customer requests a contraceptive or a medication related to a contraceptive that is in stock1 the pharmacy shall ensure that the contraceptive or the medication related to a contraceptive is provided to the customer without delay4 7#b7 ,if a customer requests a contraceptive or a medication related to a contraceptive that is not in stock and the pharmacy in the normal course of business stocks contraception or the medication related to contraception1 the pharmacy shall immediately inform the customer that the contraceptive or the medication related to a contraceptive is not in stock and without delay offer the customer the following options3 7,a7 ,if the customer prefers to obtain the contraceptive or the medication related to a contraceptive through a referral or transfer1 the pharmacy shall-- 7i7 locate a pharmacy of the customer's choice or the closest pharmacy confirmed to have the contraceptive or the medication related to a contraceptive in stock2 and 7ii7 refer the customer or transfer the prescription to that pharmacy4 7,b7 ,if the customer prefers for the pharmacy to order the contraceptive or the medication related to a contraceptive1 the pharmacy shall obtain the contraceptive or the medication related to a contraceptive under the pharmacy's standard procedure for expedited ordering of medication and notify the customer when the contraceptive or the medication related to a contraceptive arrives4 7#c7 ,the pharmacy shall ensure that-- 7,a7 it does not operate an environment in which customers are intimidated1 threatened1 or harassed in the delivery of services relating to a request for contraception or a medication related to contraception2 7,b7 its employees do not interfere with or obstruct the delivery of services relating to a request for contraception or a medication related to contraception2 7,c7 its employees do not intentionally misrepresent or deceive customers about the availability of contraception or a medication related to contraception or its mechanism of action2 7,d7 its employees do not breach medical confidentiality with respect to a request for contraception or a medication related to contraception or threaten to breach such confidentiality2 or 7,e7 its employees do not refuse to return a valid1 lawful prescription for contraception or a medication related to contraception upon customer request4 7b7 ,contraceptives or medication related to a contraceptive not ordinarily stocked ,nothing in subsection 7a77#b7 shall be construed to require any pharmacy to comply with such subsection if the pharmacy does not ordinarily stock contraceptives or medication related to a contraceptive in the normal course of business4 7c7 ,refusals ,pursuant to ,standard ,pharmacy ,practice ,this section does not prohibit a pharmacy from refusing to provide a contraceptive or a medication related to a contraceptive to a customer in accordance with any of the following3 7#a7 ,if it is unlawful to dispense the contraceptive or the medication related to a contraceptive to the customer without a valid1 lawful prescription and no such prescription is presented4 7#b7 ,if the customer is unable to pay for the contraceptive or the medication related to a contraceptive4 7#c7 ,if the employee of the pharmacy refuses to provide the contraceptive or the medication related to a contraceptive on the basis of a professional clinical judgment4 7d7 ,relation to other laws 7#a7 ,rule of construction ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards under title ,,vii of the ,civil ,rights ,act of #aifd4 7#b7 ,certain claims ,the ,religious ,freedom ,restoration ,act of #aiic shall not provide a claim concerning1 or a defense to a claim under1 a covered title1 or provide a basis for challenging the application or enforcement of a covered title4 7e7 ,preemption ,this section does not preempt any provision of ,state law or any professional obligation made applicable by a ,state board or other entity responsible for licensing or discipline of pharmacies or pharmacists1 to the extent that such ,state law or professional obligation provides protections for customers that are greater than the protections provided by this section4 7f7 ,enforcement 7#a7 ,civil penalty ,a pharmacy that violates a requirement of subsection 7a7 is liable to the ,united ,states for a civil penalty in an amount not exceeding #a1jjj per day of violation1 not to exceed #ajj1jjj for all violations adjudicated in a single proceeding4 7#b7 ,private cause of action ,any person aggrieved as a result of a violation of a requirement of subsection 7a7 may1 in any court of competent jurisdiction1 commence a civil action against the pharmacy involved to obtain appropriate relief1 including actual and punitive damages1 injunctive relief1 and a reasonable attorney's fee and cost4 7#c7 ,limitations ,a civil action under paragraph 7#a7 or 7#b7 may not be commenced against a pharmacy after the expiration of the #e-year period beginning on the date on which the pharmacy allegedly engaged in the violation involved4 7g7 ,definitions ,in this section3 7#a7 ,the term contraception or contraceptive means any drug or device approved1 cleared1 or authorized by the ,food and ,drug ,administration to prevent pregnancy4 7#b7 ,the term employee means a person hired1 by contract or any other form of an agreement1 by a pharmacy4 7#c7 ,the term medication related to contraception or medication related to a contraceptive means any drug or device approved1 cleared1 or authorized by the ,food and ,drug ,administration that a medical professional determines necessary to use before or in conjunction with contraception or a contraceptive4 7#d7 ,the term pharmacy means an entity that-- 7,a7 is authorized by a ,state to engage in the business of selling prescription drugs at retail2 and 7,b7 employs one or more employees4 7#e7 ,the term product means a drug or device approved1 cleared1 or authorized by the ,food and ,drug ,administration4 7#f7 ,the term professional clinical judgment means the use of professional knowledge and skills to form a clinical judgment1 in accordance with prevailing medical standards4 7#g7 ,the term without delay1 with respect to a pharmacy providing1 providing a referral for1 or ordering contraception or a medication related to contraception1 or transferring the prescription for contraception or a medication related to contraception1 means within the usual and customary timeframe at the pharmacy for providing1 providing a referral for1 or ordering other products1 or transferring the prescription for other products1 respectively4 7h7 ,effective ,date ,this section shall take effect #ca days after the date of enactment of this section1 without regard to whether the ,secretary has issued any guidance or final rule regarding this section4 4