Pharmacy Refusals: State Laws, Regulations, and Policies

Fewer than half of the states in the country explicitly address the issue of refusals to provide medication to patients in the pharmacy. Eight states require pharmacists or pharmacies to ensure that patients receive their medication. Seven states allow refusals but prohibit pharmacists from obstructing patient access to medication. Only six states permit refusals without critical protections for patients, such as requirements to refer or transfer prescriptions.

Pharmacy Policy Map August 2010

Below is a description of the state policies governing pharmacy refusals. Some states have enacted statutes or regulations governing the matter that have the force of law. In other states, pharmacy boards have issued interpretations of their laws and regulations, which do not have the force of law but provide guidance about the standard of practice, and can inform disciplinary proceedings.

States with a Policy Requiring Pharmacies or Pharmacists to Provide Medications

State	Policy Applies to...	Obligation	Affected Medications	Authority
California	Pharmacist and Pharmacy	Pharmacist: may refuse only with employer’s consent Pharmacy: must ensure timely access	All drugs	Cal. Bus. & Prof. Code § 733 (2009)
Illinois	Pharmacy	Must dispense	All drugs	Ill. Admin. Code tit. 68, § 1330.500 (2010) (enjoined as to two pharmacists and the pharmacies they own in Morr-Fitz, Inc. v. Blagojevich, No. 2005-CH-000495 (Ill. Cir. Ct. 7th Jud. Cir. 04/05/11)).
Maine	Pharmacist	Must dispense	All drugs	02-392 Me. Code R. ch. 19 § 11 (Weil 2009) (citing Me. Rev. Stat. Ann. tit. 32 § 13795(2) (2009))
Massachusetts	Pharmacist	Must dispense	All drugs	Pharmacy board interpretation (2004) of Mass. Gen. Laws ch. 94C, § 19(a) (2009)
Nevada	Pharmacist	Must dispense	All drugs	Nev. Admin. Code § 639.753 (2008)
New Jersey	Pharmacy	Must dispense	All drugs	N.J. Stat. Ann. § 45:14-67.1 (West 2009)
Washington	Pharmacy	Must dispense	All drugs	Wash. Admin. Code § 246-869-010 (2009) (enjoined as to two pharmacists and a pharmacy, in Stormans, Inc. v. Selecky, No. C07-5374RBL, 2012 WL 600702 (W.D. Wash. Feb. 22, 2012)).
Wisconsin	Pharmacy	Must dispense	Contraception	Wis. Stat. Ann. § 450.095 (2009)

States with a Policy Prohibiting Obstruction or Refusals to Transfer/Refer

State	Policy Applies to...	Obligation	Affected Medications	Authority
Alabama	Pharmacist	Must provide meaningful referral/transfer	All drugs	Pharmacy board interpretation of professional obligations (2007)
Delaware	Pharmacist and Pharmacy	Pharmacist: no interference or abandoning patient Pharmacy: must accomodate pharmacist’s refusal while assuring delivery of services to patient	All drugs	Pharmacy board interpretation of professional obligations (2006); Del. Code Regs. 24 2500 § 3.1.2.4 (Weil 2009)
New York	Pharmacist and Pharmacy	Pharmacist: no interference or abandoning patient Pharmacy: must accomodate pharmacist's refusal while assuring delivery of services to patient	All drugs	Pharmacy board interpretation of professional obligations (2005)
North Carolina	Pharmacist	No obstruction; must provide meaningful referral/transfer	All drugs	Pharmacy board interpretation of professional obligations (2005)
Oregon	Pharmacist and Pharmacy	Pharmacist: notify employer; no obstruction; must provide meaningful referral/transfer Pharmacy: must accomodate pharmacist’s refusal while assuring delivery of services to patient	All drugs	Pharmacy board interpretation of professional obligations (2005)
Pennsylvania	Pharmacist and Pharmacy	Pharmacist: no interference or abandoning patient Pharmacy: must accomodate pharmacist’s refusal while assuring delivery of services to patient	All drugs	49 Pa. Code § 27.103 (2009) (statement of policy)
Texas	Pharmacist	Must provide meaningful referral/transfer	All drugs	Pharmacy board interpretation of professional obligations (2006)

States with a Policy Permitting Refusals to Dispense without Patient Protections

State	Policy Applies to...	Obligation	Affected Medications	Authority
Arizona	Pharmacy, hospital, or health professional, or any employee of a pharmacy, hospital or health professional	Must return prescription to patient	Emergency contraception or any drug or device intended to inhibit or prevent implantation of a fertilized ovum	Ariz. Rev. Stat. Ann. § 36-2154(B) (2009)
Arkansas	Pharmacists, physicians, employees, agents, and institutions	None	Contraception	Ark. Code Ann. § 20-16-304(4) (2009)
Georgia	Pharmacists	None	Any drug	Ga. Comp. R. & Regs. r. 480-5-.03(n) (2009)
Idaho	Health care professionals, licensed, certified, or registered by the state	Must notify employer of refusal in advance; must provide treatment in life-threatening situations if no-one else is available	Emergency contraception	Idaho Code § 18-611 (2010)
Mississippi	All health care providers (including pharmacists) and institutions (including pharmacies)	None	Any drug	Miss. Code Ann. § 41-107-1 to -13 (2009)
South Dakota	Pharmacists	None	Any drug “believed” to cause abortion or death	S.D. Codified Laws § 36-11-70 (2009)