Progesterone (17P) to reduce recurrent preterm birth
The Clinical and Public Health Practice Workgroup has compiled resources on the following topics to help address 17P access and utilization. 17P is a synthetic form of progesterone given by injection that has been shown to reduce risk of recurrent preterm birth by 33 percent. Women who have had a previous spontaneous singleton preterm birth, and are pregnant again with just one baby, are eligible for 17P, but many barriers to access exist.
Pharmacy administration of 17P: Examples of legislation that allow pharmacists to bill for and provide injections at local pharmacies.
Illinois SB 317 - Amendment 217 Alpha-hydroxyprogesterone caproate (17P) proposes with a physician's order, a pharmacist can administer17P-leading to ease of access for mothers with logistical challenges.
Ohio SB 332 Progesterone Supplementation Administration grants pharmacists the ability to administer the medication.
The California provider status law (SB 493) declares pharmacists as health care providers who have the authority to provide health care services, authorizing them to administer drugs and biologics when ordered by a prescriber. Previously, this was limited to oral and topical administration. SB 493 allows pharmacists to administer drugs via other methods, including by injection.
Prior authorization: Examples of state efforts to remove or streamline the prior authorization process to remove barriers to initiation for patients.
The Ohio Perinatal Quality Collaborative worked with medical directors and pharmacists from Medicaid managed care plans to remove the requirement for prior authorizations for all progesterone products.
The South Carolina Birth Outcomes Initiative (SCBOI) developed the Universal 17P Authorization Form, which allows physicians to order available formulations of 17P using the same form. The form is used for all managed care plans in the state, and indicates that the decision about which formulation to prescribe is in the hands of the physician.
Through the Mississippi Medicaid partnership, prior authorization requirements were eliminated for Makena/17P in Medicaid MCOs.
Administration outside of clinician office (home, schools, work etc.): Examples of efforts to reduce logistical barriers to obtaining 17P.
In Puerto Rico, though a public-private partnership, nurses provide women with weekly 17P injections at convenient locations such as work, school, or at home.
Optum's 17P/Makena Administration Nursing and Care Management Service provides weekly, IM administration of 17P/Makena by OB nurse, in home or at work.
Patient Education: Examples of educational tools, including posters, videos, and online content, to help increase awareness about 17P as a treatment option. Patient education can also address certain barriers to acceptance by helping women become more knowledgeable and confident about 17P.
University of North Carolina's Center for Maternal and Infant Health 17P patient education materials and videos at Mombaby.org.
Ohio Department of Health has released the Progesterone Messaging Toolkit available at GoWhenYouKnow.org. This toolkit is designed to provide Credible Messengers, such as home visitors, community health workers, local public health nurses, social workers, WIC staff and others, important information to use when speaking with women about the importance of early prenatal care, and the benefits of progesterone in reducing the risk for premature birth and infant mortality.