Your Choices For The Morning After Pill

Why do I have a toothbrush emblazoned with the active ingredient of the morning-after pill (levonorgestrel, 1.5mg)? One word: Ella. What I learned about Plan B, the generic and prescription competitions, and what you can do about the cost.

Basically, Teva, the makers of Plan B One Step, put together a breakfast of experts and some creative swag (including napkins emblazoned with the above image) to impress upon the media the distinctions between their product and the rest. Although it's fair to be healthily skeptical given the sponsorship, it was a pretty well-rounded crew that seemed intent on non-judgmental, informative takes on female sexuality and reproductive choice. And we're fortunate to live in a time and place of considerable choices. Some key tidbits:

Women (And Men) Need These Options. Duh. There are 3.1 million unintended pregnancies yearly, and half of them end in abortion. Also, I have no idea how one quantifies this, but apparently there are almost 1 million acts of unprotected sex every night. Less than half of young adults use contraception consistently when they have sex.

What's Out There. Plan B, the first to market and over the counter since 2006, has the newer selling point of coming in only one pill. (That's why they're calling it Plan B One-Step now). Next Choice, the generic, is comprised of two tablets taken twelve hours apart. Ella, which has yet to hit the market, is also one tablet, but requires a prescription. It contains a different chemical compound (ulipristal acetate) that has already been in use in some European countries; the main selling point is that it's effective up to 120 hours after intercourse, compared to the existing 72-hour range. That said, the earlier you use any "morning-after" pill, the more effective it's likely to be.

Cost. In the Q&A, the up-to-$50 cost of Plan B came up again and again. Parent company Teva's solution to this is to offer a $10 off coupon on its website that should put it on par with the generic. Public sector clinics and campus health centers can also sometimes offer emergency contraception at reduced rates. Unclear as yet how much Ella will cost and whether/which insurance plans will cover it.

For 2010, emergency contraception can be covered by health insurance plans' flexible spending accounts, but a Teva rep admitted that it could change next year when some elements of health reform kick in. "In that case it may be that women would want to get a prescription, to be allowed to use their health care spending card," she said. "We don't really know."

On the other hand, as the doctor on the panel dryly pointed out, pregnancy, and maybe having a child, is much more expensive and has more "side effects." Having an abortion can cost hundreds of dollars. But in order to believe it's worth the cost of emergency contraception, of course, you have to believe that you can actually get pregnant, which as sex educator Amber Madison pointed out, few young women take seriously as a possibility.

The Access Factor. Women — or men, they were careful to emphasize — over 17 can get Plan B or Next Choice over the counter. (Younger than that, you need a prescription.) When Plan B was first introduced, it was prescription-only, but the Teva team cited a study that showed 97 percent of women said over-the-counter access was important to them. It's still kept behind the counter for regulatory reasons, but as the pharmacist on the panel kept saying, just because you don't see it doesn't mean they don't carry it. If you don't want to ask for it, Plan B's website has request cards you can print out and hand to the pharmacist. No records are kept of your purchase, another misinformation out there.

Clearly, one reason Teva believes it'll be able to stave off competition from Ella is the doctor element and the fact that "pregnancy needs to be excluded" before you take it (because if you are pregnant, none of these pills will reverse that.) They suggested women might need to take pregnancy tests before taking Ella because its compound may or may not hurt an embryo, but when I asked if that meant pregnancy tests were required, they simply repeated that "pregnancy needs to be excluded," which appears to mean that the regulatory wording is fuzzy.

They also pointed out that the active ingredient in Plan B is the same as what's in regular birth control pills and has a longer track record of safety (including in the event that you are already pregnant) than what's in Ella, ulipristol acetate. That's true, but they're not exactly an unbiased source there in pointing it out.

Oh, And Also. Demand for emergency contraception increases, um, cyclically — campuses can run out around big events like football games, and the day after Valentine's Day is a big seller. But it has a pretty long shelf life — they said yesterday up to four years — so you may want to stock one in case of emergency. Also, using a Plan B toothbrush the morning after will not prevent pregnancy.

Related: Morning-After Pill (Emergency Contraception) [Planned Parenthood]