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Emergency Contraception: No Help if Women Still Can't Get It

Although Plan B, the 'morning after pill,' became available without prescription in November, women still face high costs, age restrictions, and limited availability in some places.
 
 
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Barr Laboratories began shipping Plan B to pharmacies nationwide on Nov. 6 on the non-prescription basis recently approved by the federal Food and Drug Administration.

That puts the pill within much easier reach.

But while access is now enhanced to the time-sensitive drug, barriers -- including some prices nearing $45 -- remain.

Because of its new non-prescription status, Carol Cox, a spokeswoman for Barr Labs, told Women's eNews that the distributor does not expect insurance companies to provide coverage for it and that Medicaid does not cover Plan B in all states.

Health advocates recommend that, because it can still be difficult to buy Plan B on a timely and affordable basis, women should buy the emergency contraception even if they don't need it, just to be on the safe side.

Women who can't afford to buy Plan B can try clinics in some regions, such as Planned Parenthood, that will provide the product on a sliding-fee basis.

Because of the age restriction imposed by the FDA, most women under 18 years old must still acquire a prescription for it.

Exceptions are women under 18 who live in Alaska, Hawaii, California, Massachusetts, Maine, New Hampshire, New Mexico, or Vermont. They may be able to get Plan B directly from a pharmacist who participates in the state's pharmacy access program, according to the National Women's Law Center. States in this program allow Barr to ship the drug directly to participating pharmacists, rather than stores.

Women can also get men to buy Plan B.

"The great thing is that there are no barriers to men buying the pill," said Lisa Wynn, a research associate at the Office for Population Research at Princeton University. "The barrier is an age barrier. And for women under 18, they can get an older boyfriend or sister to buy the pill for them."

"I think we're seeing an increase in men who want to take more responsibility -- or control, if you will -- over contraception," Wynn said. "After all, if you're facing the choice between 18 years of paying monthly child support or spending $45 on Plan B, well, it's a no-brainer."

Photo ID Required

Male or female, however, those purchasing Plan B will still have to show a photo ID to prove they are old enough.

This includes anything from an expired U.S. passport, to a driver's license, a school identification card, U.S. military draft card, or a voter's registration card, according to Not-2-Late.com, an emergency contraceptive web resource jointly run by the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals, a Washington, D.C.-based nonprofit.

Government-issued IDs may pose a problem for undocumented aliens, says Wynn. The FDA listed Canadian drivers' licenses, but didn't mention Mexico or any other countries, Wynn said.

Plan B is technically available "over the counter," but in fact it's going to be mainly kept behind the counter. Because of the FDA's age restriction, it can only be sold at pharmacies, many of which are not open 24-hours a day. A pharmacist must be on duty to dispense it.

Plan B should be used as soon as possible after unprotected sex. If taken within 72 hours it is 89 percent effective, says Barr Labs. But women may have trouble locating a pharmacy that is open on a holiday or some portions of the weekend.

Pharmacist Contact Required

For some women, contact with the pharmacist also poses a barrier.

James Trussell, an emergency-contraception expert also at Princeton, says Not-2-late.com receives an average of five e-mails a day from women expressing anxiety about purchasing Plan B.

"There is always a psychological barrier in speaking about a contraceptive failure," Wynn said. "It becomes relevant when you come into a small town, when women know the pharmacist behind the counter."

Embarrassment may play a role in purchasing condoms, too, which are under lock and key in some drug stores throughout the country.

In April the Washington Post reported that CVS stores in the nation's capital, in an anti-theft measure, locked condoms in a case and required customers to push a button for assistance. Jessica Valenti posted the article on her web site, Feministing.com, and in response readers from New Mexico, Georgia, and Pennsylvania said that Smiths and Kroger pharmacies, the national chain based in Salt Lake City, Utah, also kept condoms locked up.

Under pressure from women's rights groups, some CVS stores in Washington, D.C., now keep a handful of condoms unlocked in a store display so customers can have easier access to the prophylactic, DeAngelis told Women's eNews.

Major Chains Stock Drug

As for Plan B, Mike DeAngelis, spokesperson for CVS, said every CVS nationwide will sell the drug for $44.99. Walgreens, Rite Aid, Target, and Wal-Mart will also be selling the drug around the country, corporate spokespersons from each company told Women's eNews.

Some Wal-Marts offer Plan B for $35, said Kory Lundberg, a manager at Wal-Mart's corporate headquarters in Bentonville, Ark.

Nationwide Retail chain pharmacies and wholesalers, who will sell Plan B to independent drug stores without warehousing capabilities, are also buying the product, Cox said. Barr sells Plan B to these outlets for $27.95.

"As a result of this distribution, we expect that Plan B is available widely across the United States," Cox said.

There is still lingering concern, however, about Plan B's availability at independent drug stores in small towns.

Pharmacies in six counties offered no Plan B at all, the Reproductive Freedom Project at the American Civil Liberties Union in Louisville, Kentucky, found in a January report. The authors said this could be a serious problem for women in rural areas where the closest pharmacy with Plan B in stock could be 100 miles away.

The report also found that pharmacists can be misinformed about how the pill works. One pharmacist asked if Plan B was a vitamin, while another said "it causes a spontaneous abortion."

According to Not-2-late.com, Plan B does not end a pre-existing pregnancy. It usually works to delay ovulation -- the release of the egg from the ovaries.

"I think some of what will change is general awareness," said Amanda Kreps-Long, director of the Reproductive Freedom Project. "I got an e-mail (from Barr) that went to Walgreen pharmacists, which explained how Plan B works." The e-mail was sent on Nov. 16.

Jeanine Plant is a New York-based freelance writer.