Case Review: Pharmacist Loses Job After Refusing to Fill Hormone Rx

This month we look at a situation that has been in headlines lately. While a lawsuit was not filed in this case, the pharmacist involved still lost his job. The issue: can a pharmacist refuse to fill a valid prescription for a patient if the pharmacist has a moral problem with it?

Just the Facts

The incident took place in Arizona. The patient, Ms. H, a transgender woman was leaving her doctor’s office with her first prescriptions for hormone therapy. She wrote about what happened next in a blog post published on the American Civil Liberties Union (ACLU) website. “I left my doctor’s office elated,” Ms. H wrote. “I was finally going to start seeing my body reflect my gender identity and the woman I’ve always known myself to be.”

She took the prescriptions to her regular CVS pharmacy where things took an unfortunate turn. According to Ms. H, the pharmacist refused to fill her prescription. “He did not give me a clear reason for the refusal,” wrote Ms. H. “He just kept asking, loudly and in front of other CVS staff and customers, why I was given the prescriptions.” Embarrassed and upset, Ms. H asked for the prescriptions back. The pharmacist refused to return them. Not knowing what else to do, the patient left the pharmacy and called her doctor’s office to explain what had happened. The office called the pharmacist, who still refused to fill the prescription, transfer it elsewhere, or explain his refusal to fill it. Ultimately, the physician ended up calling the prescription in to a rival chain pharmacy which filled it without question.

Ms. H filed a complaint with CVS and the Arizona Board of Pharmacy, and shared her story via the ACLU, which launched an online petition -- “CVS: Transgender Customers Need Their Prescriptions, Too.”  As of late July, the petition had over 28 thousand signatures.

CVS responded by apologizing to Ms. H, and by firing the pharmacist who refused to fill the prescription. According to CVS, the pharmacist had violated company policy which required him to notify the company about any religious beliefs in advance so that the company could make other arrangements to ensure all patients’ needs are met.

The Law

Arizona is one of only a handful of states which allow pharmacists to refuse to fill certain prescriptions, usually for abortion-related medications, on moral or religious grounds. However, most, if not all, pharmacies (particularly the large chains) have policies in place to ensure that even if a pharmacist were to object to filling a prescription, the patient would still be able to get her medication – either another pharmacist would fill it, or it would be transferred to another pharmacy, or certainly it would be returned to the patient so that she could go elsewhere.

Ms. H’s case differs from a similar situation that happened in Arizona a few weeks earlier. In that situation, a Walgreens pharmacist refused to fill a prescription for an abortion medication for a patient whose fetus had died in vitro. Although the pharmacist refused to fill the prescription, he transferred it to another Walgreens and complied with company policy which allowed him to step away from filling a prescription for moral reasons as long as the needs of the patient are met in a timely manner. While the company apologized to that patient for her treatment, the pharmacist was not fired.

The Takeaway

Very few states allow pharmacists to refuse to fill a prescription on religious or moral grounds, and those that do often specify (as Arizona did) what specifically a pharmacist may object to. (In Arizona – “abortion, abortion medication, emergency contraception or any medication or device intended to inhibit or prevent implantation of a fertilized ovum.”) Note – this does not include hormone therapy for transgender patients.

If you have some objection (other than a valid medical objection) to filling a prescription based on religious or moral grounds, be sure you know what your company policy is. Your company may allow you to avoid filling a prescription you object to, but alternatives for the patient with a valid prescription must be provided. If you violate your company’s policies, and leave patients without options for legitimate prescriptions, you are very likely to lose your job, as happened to the Arizona pharmacist.

Regardless of how you personally feel about any prescription, making a patient feel embarrassed or guilty about a legal prescription is unprofessional and unacceptable, and likely to result in the loss of your employment.

Ann W. Latner, JD, is a freelance writer and attorney based in New York. She was formerly Director of Periodicals at the American Pharmacists Association.

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