Systematic review of interest-holder perceptions of pharmacist-prescribed ulipristal acetate emergency contraception

Background: Emergency contraception (EC) is important for the prevention of unintended pregnancy. Objectives: This systematic review aimed to evaluate literature assessing interest-holder perceptions of pharmacist-prescribed ulipristal acetate (UPA) EC. Methods: A search of Embase, MEDLINE, and PubMed was conducted from inception to March 3, 2025, using the following search terms and permutations: ulipristal, ella, emergency contraception, pharmacist, and pharmacy. Eligibility criteria included the following: primary literature pertaining to pharmacist-prescribed UPA EC, studies reporting on data collected in the United States, studies related to interest-holder (pharmacist, patient, and other interest-holder) perceptions, and full reports in English. Abstract-only records were excluded. Reviewers extracted and synthesized data including study characteristics and interest-holder perceptions of pharmacist-prescribed UPA. Qualitative data were coded for themes. Risk of bias (ROB) was assessed using the Appraisal tool for Cross-Sectional Studies and the Joanna Briggs Institute Narrative Critical Appraisal tool. Results: The search yielded 1906 records; 1298 were screened after deduplication and limited to English and humans. Seven records met the inclusion criteria: 6 California-based cross-sectional studies and 1 Indiana-based pilot study. Eleven outcomes regarding pharmacist, patient, and other interest-holder perceptions were identified; 5 reports included outcomes regarding pharmacists’ perceptions, 3 included patient perceptions, and 2 included a small amount of other interest-holder perceptions. Pharmacists in 3 of 5 reports cited barriers to pharmacist-prescribed UPA; the most common included time, reimbursement for services, and support via staffing, workflow, and management. Pharmacists in 2 of 5 reports expressed desire for additional training. Patients reported benefits of pharmacist-prescribed UPA including reduced cost, time, and improved accessibility in 1 of 2 reports. Other interest holders supported pharmacist-prescribed UPA. All 7 reports had high ROB owing to the response rate. Conclusion: Pharmacist-prescribed UPA can enhance access to EC. Education, reimbursement, and support barriers must be addressed, in addition to legislation expansion, to enhance implementation.