Julia*, a 25-year-old Manhattanite, was perplexed when she was carded at her local Rite Aid last weekend while trying to purchase the morning-after pill. She thought the FDA had recently approved OTC emergency contraception for all ages, so figured she'd be able to buy it with ease; instead, she had to ask an employee to help her obtain a paper placeholder from the "Family Planning" aisle's alarm-protected section, which she was instructed to bring to the pharmacy. The clerk asked her if she wanted Plan B One-Step or the generic version, which was $10 cheaper; when she chose the latter, she had to show ID. "The whole process was bizarre," Julia said. "Why is it still so complicated to buy an over-the-counter drug?"
Good question! The FDA's decision to grant market exclusivity to Teva Pharmaceuticals for over-the-counter Plan B One-Step for the next three years created a "patchwork system that's only going to result in continued confusion for consumers and retailers," said Jessica Arons, President and CEO of the Reproductive Health Technologies Project, a reproductive freedom advocacy group. Basically, it means that Plan B One-Step, which generally sells for about $40-50, will be the only emergency contraception product available over the counter for women younger than 17 until 2016. Soon, generic one-pill products (Next Choice One Dose and My Way) will be on shelves next to Plan B One-Step, but you'll need to prove you're 17 or older to buy them for around $35-45 a pop. If Plan B One-Step isn't available, teenagers 16 and younger will have to get a prescription for ella or generic two-pill Levonorgestrel tablets.
Confusing, right? Problematic, too. According to a nationwide survey conducted by the American Society for Emergency Contraception, generic emergency contraception doesn't cost dramatically less than Plan B One-Step, but the price difference still makes it less accessible. Not all pharmacies stock Plan B One-Step; 20% of the 400 retail pharmacies included in the survey sold only generics. Even Teva is aware of the issue, which is why its website has a locator service that can "find a store in your area that may carry Plan B One-Step" and urges people to call beforehand to make sure it's in stock. Most young teenagers who're trying to get their hands on the morning-after pill as soon as possible probably won't plan that far ahead.
The obstacles don't stop there. Kelly Cleland, a researcher at Princeton University and executive director of the American Society for Emergency Contraception, said many pharmacies keep Plan B One-Step locked behind plastic boxes, ostensibly to prevent theft. (That's why Julia couldn't get emergency contraception without assistance.) "Some pharmacies say they have to keep a close eye on expensive products behind the counter, which is very possible, but it could be used as an excuse by pharmacists who don't want to sell to make it more difficult to get," Cleland said.
We can blame Democrats and Republicans for the three year wait until generics can be sold over the counter without any ID/Rx restrictions; members of both parties have argued for years that teenagers can't handle the extremely safe and effective medication, which is why the normal lifecycle from brand name drugs to generics was elongated.
The EC multi-tiered hierarchy is "incredibly complicated," Arons said. "I don't know if that's the intent or just the effect, but it means a lot of confusion will continue to surround emergency contraception; that alone will create barriers for women of all ages. It's an incredibly unfortunate byproduct of politics."
On August 1, the day Teva said it anticipated Plan B One-Step to be available in major retailers nationwide (Some women in metropolitan areas spotted it earlier; by now, Arons said, pharmacies that don't carry it "have no excuse"), Reproductive Health Technologies Project launched the ECOTC Tumblr, where you can find helpful infographics and community education tools to print out and give to retailers. Having trouble getting emergency contraception? You can report problems here.
The lack of straightforward information about the new guidelines contributes to the pervasive notion that emergency contraception is scary and tricky, Arons and Cleland said, even though studies show it's safer than Advil. "Because of political interference with Plan B, we have major confusion about who can purchase it and whether these products are safe," Arons said. "It feeds into histrionics." Dispel the myth by passing this on to the teens in your life.
*Not her real name.
Image by Jim Cooke.