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EC: Family planners still advocate access
August 2007 marked the first anniversary of the Food and Drug Administration's (FDA) approval of over-the-counter (OTC) status for the emergency contraceptive Plan B (Barr Pharmaceuticals; Pomona, NY). How has the change affected how family planning clinicians work with emergency contraception (EC)?
Not much, according to the results of the 2007 Contraceptive Technology Update survey. About 83% report their facilities prescribe EC onsite and provide EC pills at any time, slightly lower than 2006's 88% figure. However, 69% say they prescribe advance provision of EC, up from 2006's 66% statistic.
While women and men ages 18 and older are now able to buy the drug without a prescription at participating pharmacies, Plan B remains prescription-only for women younger than 18. The nonprescription version of the drug is kept behind pharmacy counters, and proof of age must be shown prior to purchase. Duramed, Barr Pharmaceutical's subsidiary, began shipping the dual-label EC product in November 2006.
Consumers are watching ads
Consumer advertising for the new form of Plan B may have raised awareness about emergency contraception, report respondents to the CTU annual survey. Use of Plan B has almost doubled in the last year at Hill County Family Planning in Havre, MT, says director Karen Sloan, RNCNP. "All our new clients see a video that I made that discusses all forms of birth control and talks about Plan B," she says. These people tell their friends, she adds. "We advertise in the local paper and the college phone book and, on our answering machine, we have a message about the 'morning-after pill,'" Sloan says.
Numbers for EC requests also have increased at Virginia Commonwealth University Student Health Service in Richmond, says Nancy Harris, NP, a nurse practitioner at the facility. Center clinicians inform students about the availability of EC when they come in for health visits, as well as provide information in the waiting room and on its web page. The center also provides an EC "blackboard in a bag" — a blackboard presentation that residence advisors (RAs) can access to put up on their dorm floors. The "blackboard in a bag" is in a computerized graphic format and allows RAs to print it out to be displayed on dorm bulletin boards, explains Harris. The presentation, developed by the health center at minimal cost, covers basic information on EC and reminds women to seek sexually transmitted disease (STD) testing as well if they have had sex with a new partner. It also includes counseling contact information for women who may have been sexually assaulted.
Who pays for OTC?
Continuing to write prescriptions for emergency contraception makes sense for two reasons. For example, Martha Cole, MD, a private practice obstetrician/gynecologist in Bethesda, MD, says she writes advance prescriptions for EC because patients tell her that paying for OTC EC out of pocket is more expensive than having the prescription filled, with insurance picking up the cost.
Secondly, some women with Medicaid coverage may not be getting coverage for OTC emergency contraception. According to the Emergency Contraception web site (www.not-2-late.com), Medicaid currently covers no OTC product in about one-third of states. Nearly another third of states have Medicaid coverage for some OTC products, while the remaining one-third have coverage of many products. A group of advocacy organizations is working to tackle this and other access issues for low-income women, reports the web site.
Most state Medicaid programs still require a prescription for drug reimbursement, according to the National Institute for Reproductive Health/ NARAL Pro-Choice New York. Women on Medi-caid have to pay out of pocket for the drug, which averages about $50, or obtain a provider prescription to obtain coverage.1
Eight states (Hawaii, Illinois, Maryland, New Jersey, New York, Oklahoma, Oregon, and Washington) have revised their Medicaid legislation to cover OTC emergency contraception. Other states are looking at revising statutes to include coverage.
The National Health Law Program, a public interest law firm that seeks to improve health care for the working and unemployed poor, children, people with disabilities, and people of color, has published Over the Counter or Out of Reach? A Report on Evolving State Medicaid Policies for Covering Emergency Contraception. The publication offers a chart that maps policies in all 50 states, as well as a resource list for each state. An online version of the document is available on the agency's web site, www.healthlaw.org. Click on the publication's title under the subheading, "NHeLP Publication."
The National Institute for Reproductive Health/ NARAL Pro-Choice New York offers a publication, Expanding Medicaid Coverage for EC on the State Level, which outlines how eight states have changed their Medicaid policies to cover OTC EC. The publication also includes a set of recommendations to help advocates ensure that low-income women have access to EC. An online version of the publication is available at NARAL Pro-Choice New York's web site, www.prochoiceny.org. Click on "Medicaid and EC," then "Learn More." Click on the publication title to download it.