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.
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) |