EC: Family planners weigh in on method use
Will you change your prescribing practice with the Food and Drug Administration's (FDA) recent approval of over the counter (OTC) status for the emergency contraceptive Plan B?
Responses to the 2006 Contraceptive Technology Update survey, conducted before the FDA approval, show that family planners are firmly behind easy access to emergency contraception (EC). About 87% report their facilities prescribe EC onsite and provide EC pills at any time, slightly above 2005's figures. About 66% say they prescribe advance provision of EC, almost a 10% jump from 2005's statistics.
The FDA gave approval in August 2006 to Pomona, NY-based Barr Pharmaceuticals' request to provide nonprescription access to the company's levonorgestrel EC pill, Plan B.
The FDA approval does not provide "all access" to the drug, though. Plan B will remain prescription-only for women younger than age 18; women and men ages 18 and older will be able to buy the drug without a prescription at participating pharmacies. The nonprescription version of the drug will be kept behind pharmacy counters, and proof of age must be shown prior to purchase.
Duramed, Barr Pharmaceutical's subsidiary, plans to introduce the dual-status Rx/OTC version of the product before the end of the calendar year.1
Advance prescription of EC still is important for women of all ages, because insurance may not pay for the behind-the-counter packs, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles (UCLA) and medical director of the women's health care programs at Harbor-UCLA Medical Center in Torrance.
How much will Plan B cost over-the-counter? The price has not been decided and may vary by pharmacy; prescription price for the drug now ranges from $20-$50. "Have patients shop around for the best price," Nelson advises. "Plan B may be expensive at some pharmacies."
Even when the nonprescription Plan B goes on the market, women will need to continue to hear about EC. In reviewing studies of EC use,2-11 James Trussell, PhD, professor of economics and public affairs and director of the Office of Population Research at Princeton (NJ) University, says the following lessons are applicable:
- Emergency contraceptive pills are not used nearly frequently enough.
- Women underestimate their risk of pregnancy.
- More education is necessary.
- The OTC switch is necessary — but not sufficient — for solving this problem.
- Major public health impact is unlikely.12
California, Washington, Alaska, Hawaii, New Mexico, Maine, New Hampshire, Massachusetts, and Vermont have legislation in place allowing specially trained pharmacists to provide Plan B to women without a doctor's prescription. In addition, a few pharmacists in Montana provide Plan B under collaborative agreement with physicians. What will happen in the pharmacy access states where women already can get Plan B without a doctor's prescription when the nonprescription drug hits market shelves?
According to the recently redesigned web site, not-2-late.com, the FDA ruling will not change existing pharmacy access programs unless those states pass new legislation to change them. In pharmacy access states, women younger than the age of 18 still will be able to obtain Plan B without a doctor's prescription through specially trained and licensed pharmacists, the site reports.
Where do you stand when it comes to EC? Lori Jagoda, PHN, a public health nursing supervisor at Amador County Health Department in Jackson, CA, says her facility is giving out more Plan B in advance, so clinicians are not seeing as many walk-in requests as in the past.
"We have initiated giving out Plan B to have on hand to all clients who come in to start a method birth control; in addition, if a client comes in for ECPs, we give them an extra pack to have on hand if they need it before starting a regular method of birth control," she states. "One of our local pharmacies has also partnered with us and dispenses ECPs to those seeking it after hours and weekends."
References
- Barr Pharmaceuticals. FDA Grants OTC Status to Barr's Plan B Emergency Contraceptive. Press release. Woodcliff Lake, NJ; Aug. 24, 2006. Accessed at: phx.corporate-ir.net/ phoenix.zhtml?c=60908&p=irol-newsArticle&ID= 899120.
- Raine TR, Harper CC, Rocca CH, et al. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: A randomized controlled trial. JAMA 2005; 293:54-62.
- Hu X, Cheng L, Hua X, et al. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: A randomized controlled trial. Contraception 2005; 72:111-116.
- Raymond EG, Stewart F, Weaver M, et al. Randomized trial to evaluate the impact of increased access to emergency contraceptive pills. Obstet Gynecol 2006; 108: in press.
- Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception 2006; 74:110-117.
- Belzer M, Sanchez K, Olson J, et al. Advance supply of emergency contraception: A randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol 2005; 18:347-354.
- Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998; 339:1-4.
- Raine T, Harper C, Leon K, et al. Emergency contraception: Advance provision in a young, high-risk clinic population. Obstet Gynecol 2000; 96:1-7.
- Jackson RA, Schwarz EB, Freedman L, et al. Advance supply of emergency contraception: Effect on use and usual contraception — a randomized trial. Obstet Gynecol 2003; 102:8-16.
- Gold MA, Wolford JE, Smith KA, et al. The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004; 17:87-96.
- Trussell J, Raymond E, Stewart FH. Advance supply of emergency contraception: A randomized trial in adolescent mothers [Letter to the editor]. J Pediatr Adolesc Gynecol 2006; 19:251.
- Trussell J. Topics in emergency contraception. Presented at the 2006 Association of Reproductive Health Professionals (ARHP) conference. La Jolla, CA; September 2006.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content