II 

118TH CONGRESS 

2D SESSION S. 4223 

To establish certain duties for pharmacies to ensure provision of Food and 

Drug Administration-approved contraception, medication related to contraception, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 1, 2024 

Mr. BOOKER (for himself, Ms. SMITH, Mr. MERKLEY, Mr. BLUMENTHAL, Mr. 

KAINE, Mr. PADILLA, Mr. WHITEHOUSE, Mr. HEINRICH, Ms. 

DUCKWORTH, Ms. WARREN, Ms. ROSEN, Mr. MENENDEZ, Ms. BUTLER, 

Mr. MURPHY, Mr. VAN HOLLEN, Ms. HIRONO, Mrs. GILLIBRAND, Mrs. 

SHAHEEN, Mr. WARNER, Ms. BALDWIN, Mr. WYDEN, Ms. STABENOW, 

and Mr. BROWN) introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To establish certain duties for pharmacies to ensure provision 

of Food and Drug Administration-approved contraception, medication related to contraception, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Access to Birth Control 

5 Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds as follows: 

3 (1) Family planning is basic health care. Access 

4 to contraception helps people determine if and when 

5 to become pregnant. Contraception is also a corner6 stone of reproductive autonomy and can help people 

7 fulfill their educational, professional, and social aspi8 rations. 

9 (2) As a result of the enactment of the Patient 

10 Protection and Affordable Care Act (Public Law 

11 111–148), approximately 151,600,000 individuals in 

12 the United States were enrolled in private health in13 surance plans in the United States in 2020, includ14 ing 58,000,000 women between the ages of 19 and 

15 64 who had coverage of contraceptive methods ap16 proved, cleared, or authorized by the Food and Drug 

17 Administration without cost sharing under such 

18 plans. 

19 (3) The Patient Protection and Affordable Care 

20 Act saved women $1,400,000,000 on birth control 

21 pills alone in 2013. 

22 (4) According to the Centers for Disease Control and Prevention, nearly 2 23 ⁄3 of women between the 

24 ages of 15 and 49 are currently using a contracep25 tive method and among sexually active women who 


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1 were not seeking pregnancy, nearly 9 in 10 have 

2 used contraception. 

3 (5) Although the Centers for Disease Control 

4 and Prevention included family planning in its pub5 lished list of the Ten Great Public Health Achieve6 ments in the 20th Century, people in the United 

7 States face a myriad of barriers in accessing birth 

8 control, including cost, geography, immigration sta9 tus, language access, discrimination, and stigma. 

10 These contraceptive barriers are rooted in systemic 

11 inequities, structural racism, and other forms of op12 pression in our health care system and society. 

13 (6) In 2019, approximately 2,293,000 preg14 nancies, nearly 42 percent of all pregnancies, in the 

15 United States were unintended. 

16 (7) Systemic racism and discrimination, as well 

17 as lack of access to comprehensive sex education, ex18 acerbates severe health inequities and creates addi19 tional barriers to accessing contraception; for exam20 ple, due to high uninsured rates and barriers, His21 panic women with low incomes experience a signifi22 cantly higher rate of unintended pregnancy (58 per23 cent) compared to their White counterparts (33 per24 cent). In a 2023 study exploring challenges access25 ing contraceptive care among people who identified 


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1 as Asian American, Native Hawaiian, or Pacific Is2 lander, Black or African American, Indigenous, or 

3 Latina/Latinx, 45 percent of respondents reported 

4 experiencing at least one challenge accessing contra5 ception in the past year. 

6 (8) In addition to preventing pregnancy, contra7 ceptives are used for a range of medical purposes, 

8 such as treating abnormal uterine bleeding, irregular 

9 menstrual cycles, and endometriosis, as well as for 

10 people managing other chronic conditions, which are 

11 generally higher in communities of color due to sys12 temic discrimination. 

13 (9) The Food and Drug Administration has ap14 proved, cleared, or authorized multiple emergency 

15 contraceptive methods as safe and effective in pre16 venting unintended pregnancy and has approved 

17 over-the-counter access to some forms of emergency 

18 contraception for all individuals, regardless of age. If 

19 taken soon after unprotected sex or primary contra20 ceptive failure, emergency contraception can signifi21 cantly reduce a person’s chance of unintended preg22 nancy. Additionally, in 2023, the Food and Drug 

23 Administration approved the first over-the-counter 

24 daily birth control pill which will give people of all 


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1 ages greater access to birth control options without 

2 a prescription. 

3 (10) Contraception is a protected fundamental 

4 right in the United States and access to contracep5 tion should not be impeded by one individual’s per6 sonal beliefs. Providers, including pharmacists, play 

7 a key role in providing contraceptive services and 

8 important information about prescription and over9 the-counter birth control options to people across the 

10 country. It is critical that contraceptive care is pro11 vided to people of all ages in a supportive way that 

12 is culturally appropriate and delivered without stig13 ma, bias, or delay. 

14 (11) Reports of pharmacists refusing to fill pre15 scriptions for contraceptives, including emergency 

16 contraceptives, or provide emergency contraception 

17 over-the-counter have surfaced in States across the 

18 Nation, including Alabama, Arizona, California, the 

19 District of Columbia, Georgia, Illinois, Louisiana, 

20 Massachusetts, Michigan, Minnesota, Missouri, Mon21 tana, New Hampshire, New Mexico, New York, 

22 North Carolina, Ohio, Oklahoma, Oregon, Rhode Is23 land, Tennessee, Texas, Washington, West Virginia, 

24 and Wisconsin. 


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1 (12) Since the Supreme Court decision in 

2 Dobbs v. Jackson Women’s Health Organization 

3 (142 S. Ct. 2228 (2022)), there have been increased 

4 reports of people being denied birth control at phar5 macies. 

6 (13) In 2022, the Department of Health and 

7 Human Services issued guidance clarifying that re8 fusing to dispense birth control can be sex discrimi9 nation under section 1557 of the Patient Protection 

10 and Affordable Care Act (42 U.S.C. 18116). 

11 SEC. 3. DUTIES OF PHARMACIES TO ENSURE PROVISION OF 

12 CONTRACEPTION AND MEDICATION RE13 LATED TO CONTRACEPTION. 

14 Part B of title II of the Public Health Service Act 

15 (42 U.S.C. 238 et seq.) is amended by adding at the end 

16 the following: 

17 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 

18 OF CONTRACEPTION AND MEDICATION RE19 LATED TO CONTRACEPTION. 

20 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 

21 pharmacy that receives drugs or devices approved, cleared, 

22 or authorized by the Food and Drug Administration in 

23 interstate commerce shall maintain compliance with the 

24 following: 


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1 ‘‘(1) If a customer requests a contraceptive or 

2 a medication related to a contraceptive that is in 

3 stock, the pharmacy shall ensure that the contracep4 tive or the medication related to a contraceptive is 

5 provided to the customer without delay. 

6 ‘‘(2) If a customer requests a contraceptive or 

7 a medication related to a contraceptive that is not 

8 in stock and the pharmacy in the normal course of 

9 business stocks contraception or the medication re10 lated to contraception, the pharmacy shall imme11 diately inform the customer that the contraceptive or 

12 the medication related to a contraceptive is not in 

13 stock and without delay offer the customer the fol14 lowing options: 

15 ‘‘(A) If the customer prefers to obtain the 

16 contraceptive or the medication related to a 

17 contraceptive through a referral or transfer, the 

18 pharmacy shall— 

19 ‘‘(i) locate a pharmacy of the cus20 tomer’s choice or the closest pharmacy 

21 confirmed to have the contraceptive or the 

22 medication related to a contraceptive in 

23 stock; and 

24 ‘‘(ii) refer the customer or transfer 

25 the prescription to that pharmacy. 


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1 ‘‘(B) If the customer prefers for the phar2 macy to order the contraceptive or the medica3 tion related to a contraceptive, the pharmacy 

4 shall obtain the contraceptive or the medication 

5 related to a contraceptive under the pharmacy’s 

6 standard procedure for expedited ordering of 

7 medication and notify the customer when the 

8 contraceptive or the medication related to a 

9 contraceptive arrives. 

10 ‘‘(3) The pharmacy shall ensure that— 

11 ‘‘(A) it does not operate an environment in 

12 which customers are intimidated, threatened, or 

13 harassed in the delivery of services relating to 

14 a request for contraception or a medication re15 lated to contraception; 

16 ‘‘(B) its employees do not interfere with or 

17 obstruct the delivery of services relating to a re18 quest for contraception or a medication related 

19 to contraception; 

20 ‘‘(C) its employees do not intentionally 

21 misrepresent or deceive customers about the 

22 availability of contraception or a medication re23 lated to contraception or its mechanism of ac24 tion; 


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1 ‘‘(D) its employees do not breach medical 

2 confidentiality with respect to a request for a 

3 contraception or a medication related to contra4 ception or threaten to breach such confiden5 tiality; or 

6 ‘‘(E) its employees do not refuse to return 

7 a valid, lawful prescription for a contraception 

8 or a medication related to contraception upon 

9 customer request. 

10 ‘‘(b) CONTRACEPTIVES OR MEDICATION RELATED TO

11 A CONTRACEPTIVE NOT ORDINARILY STOCKED.—Noth12 ing in subsection (a)(2) shall be construed to require any 

13 pharmacy to comply with such subsection if the pharmacy 

14 does not ordinarily stock contraceptives or medication re15 lated to a contraceptive in the normal course of business. 

16 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR17 MACY PRACTICE.—This section does not prohibit a phar18 macy from refusing to provide a contraceptive or a medi19 cation related to a contraceptive to a customer in accord20 ance with any of the following: 

21 ‘‘(1) If it is unlawful to dispense the contracep22 tive or the medication related to a contraceptive to 

23 the customer without a valid, lawful prescription and 

24 no such prescription is presented. 


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1 ‘‘(2) If the customer is unable to pay for the 

2 contraceptive or the medication related to a contra3 ceptive. 

4 ‘‘(3) If the employee of the pharmacy refuses to 

5 provide the contraceptive or the medication related 

6 to a contraceptive on the basis of a professional clin7 ical judgment. 

8 ‘‘(d) RELATION TO OTHER LAWS.— 

9 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 

10 this section shall be construed to invalidate or limit 

11 rights, remedies, procedures, or legal standards 

12 under title VII of the Civil Rights Act of 1964. 

13 ‘‘(2) CERTAIN CLAIMS.—The Religious Free14 dom Restoration Act of 1993 shall not provide a 

15 claim concerning, or a defense to a claim under, a 

16 covered title, or provide a basis for challenging the 

17 application or enforcement of a covered title. 

18 ‘‘(e) PREEMPTION.—This section does not preempt 

19 any provision of State law or any professional obligation 

20 made applicable by a State board or other entity respon21 sible for licensing or discipline of pharmacies or phar22 macists, to the extent that such State law or professional 

23 obligation provides protections for customers that are 

24 greater than the protections provided by this section. 

25 ‘‘(f) ENFORCEMENT.— 


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1 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio2 lates a requirement of subsection (a) is liable to the 

3 United States for a civil penalty in an amount not 

4 exceeding $1,000 per day of violation, not to exceed 

5 $100,000 for all violations adjudicated in a single 

6 proceeding. 

7 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 

8 aggrieved as a result of a violation of a requirement 

9 of subsection (a) may, in any court of competent ju10 risdiction, commence a civil action against the phar11 macy involved to obtain appropriate relief, including 

12 actual and punitive damages, injunctive relief, and a 

13 reasonable attorney’s fee and cost. 

14 ‘‘(3) LIMITATIONS.—A civil action under para15 graph (1) or (2) may not be commenced against a 

16 pharmacy after the expiration of the 5-year period 

17 beginning on the date on which the pharmacy alleg18 edly engaged in the violation involved. 

19 ‘‘(g) DEFINITIONS.—In this section: 

20 ‘‘(1) The term ‘contraception’ or ‘contraceptive’ 

21 means any drug or device approved, cleared, or au22 thorized by the Food and Drug Administration to 

23 prevent pregnancy. 


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1 ‘‘(2) The term ‘employee’ means a person hired, 

2 by contract or any other form of an agreement, by 

3 a pharmacy. 

4 ‘‘(3) The term ‘medication related to contracep5 tion’ or ‘medication related to a contraceptive’ 

6 means any drug or device approved, cleared, or au7 thorized by the Food and Drug Administration that 

8 a medical professional determines necessary to use 

9 before or in conjunction with contraception or a con10 traceptive. 

11 ‘‘(4) The term ‘pharmacy’ means an entity 

12 that— 

13 ‘‘(A) is authorized by a State to engage in 

14 the business of selling prescription drugs at re15 tail; and 

16 ‘‘(B) employs one or more employees. 

17 ‘‘(5) The term ‘product’ means a drug or device 

18 approved, cleared, or authorized by the Food and 

19 Drug Administration. 

20 ‘‘(6) The term ‘professional clinical judgment’ 

21 means the use of professional knowledge and skills 

22 to form a clinical judgment, in accordance with pre23 vailing medical standards. 

24 ‘‘(7) The term ‘without delay’, with respect to 

25 a pharmacy providing, providing a referral for, or 


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1 ordering contraception or a medication related to 

2 contraception, or transferring the prescription for 

3 contraception or a medication related to contracep4 tion, means within the usual and customary time5 frame at the pharmacy for providing, providing a re6 ferral for, or ordering other products, or transferring 

7 the prescription for other products, respectively. 

8 ‘‘(h) EFFECTIVE DATE.—This section shall take ef9 fect 31 days after the date of enactment of this section, 

10 without regard to whether the Secretary has issued any 

11 guidance or final rule regarding this section.’’. 

Æ 


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