ACOG: Plan B Availability Varies from State to State

SAN DIEGO -- Those who battled the FDA for non-prescription status of Plan B (levonorgestrel) apparently won only half the struggle. Prescription or not, Plan B can be hard to get.

A survey of Plan B availability in three major cities found that state laws can override the ease of access to the emergency contraception agent, whether by prescription or "under-the-counter" sales.

"We surveyed over 1,400 pharmacies in Atlanta, Philadelphia and Boston, and in 35% of the pharmacies in Atlanta we were told that Plan B was not available," said Rebekah Gee, M.D., of the University of Pennsylvania, in a presentation at the American College of Obstetricians and Gynecologists meeting here.

By contrast, in virtually every pharmacy in Massachusetts, Plan B, the so-called morning-after pill, was available or would be made available within 24 hours.

The difference, Dr. Gee said, was state law. In Georgia, pharmacists can elect not to carry Plan B. In Massachusetts the state legislature made it mandatory that pharmacies stock the drug, overriding the veto of Gov. Mitt Romney.

In Philadelphia, Dr. Gee said, about 23% of pharmacies did not have Plan B available. There are no laws in Pennsylvania guiding pharmacies regarding the drug.

Plan B is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization. In addition, it may inhibit implantation by altering the endometrium. It is not effective once the process of implantation has begun.

"The action of the FDA to make Plan B available without a prescription for persons over 18 years of age does not affect state regulations," said Kathryn Moore, director of ACOG's Department of State Legislative and Regulatory Activities.

The FDA program, she said, "overlays the state laws but doesn't smooth out the wrinkles. In fact, it may create new wrinkles."

For example, Moore noted that the FDA ruling provides that Plan B is available without prescription, while the Massachusetts law applies to Plan B as a prescription medication. "How the FDA ruling may impact the situation in Massachusetts is not known yet," she said.

In Dr. Gee's study, researchers surveyed 1,445 pharmacies in the three cities and got responses from 75%, a total of 1,085 drug stores.

When researchers asked whether the pharmacy was able to dispense Plan B within 24 hours, 35% of the pharmacies in Atlanta said no; 23% of the pharmacies in Philadelphia couldn't; but fewer than 5% of pharmacies in Massachusetts were unable to do so. The differences in availability proved statistically significant (P<0.001), Dr. Gee said.

She said that 35% of the pharmacies in Atlanta did not stock Plan B; 20% of pharmacies in Philadelphia did not stock it, and 5% of pharmacies in Boston did not stock it.

The researchers also found that 9% of the pharmacists in Atlanta would refuse to dispense the drug; 5% of the pharmacists in Philadelphia would refuse to dispense it.

Dr. Gee said that women should not rely on Plan Be as a main form of contraception. "It has uncomfortable side effects such as bloating, and Plan B is expensive," she said "Some pharmacies are charging as much as for it. It really should be reserved for emergency use."