States make push to widen access to EC

While the decision to make emergency contraception (EC) available over the counter remains in a holding pattern at the Food and Drug Administration, advocates are moving on the state level to allow pharmacists to dispense EC without a physician’s prescription under certain conditions.

Vermont is poised to become the ninth state to allow pharmacists to dispense EC without physician prescription. Five states (Alaska, Hawaii, Massachusetts, New Hampshire, and Washington) allow pharmacists to distribute EC when acting under a collaborative practice agreement with a physician, and two states (Maine and New Mexico) allow pharmacists to distribute EC in accordance with a state-approved protocol. In California, pharmacists can locate a prescriber to co-sign a collaborative agreement to initiate EC or work under the statewide protocol approved by the state’s Board of Pharmacy and Medical Board to furnish EC.

The Vermont Senate passed Bill H.237 on March 3; however, because the bill differed slightly from the one previously passed by the House, it was scheduled to return to the House for another vote, says Barrie-Hope Silver, marketing director of Planned Parenthood of Northern New England (PPNNE) in Williston, VT. Passage by the House was expected as of Contraceptive Technology Update’s press time. Once signed into legislation, the bill should go into effect July 1.

"PPNNE will be working hard in Vermont to establish and strengthen relationships with pharmacists and work with coalition partners to provide training to interested pharmacists on EC," says Silver. "Once trained, pharmacists will be able to enter into agreements with licensed providers so that the pharmacist can counsel on and dispense EC."

Under the new legislation, the collaborative practice protocol will be developed by rule by the state health department, explains Beth Tarallo, PPNNE’s public affairs manager for Vermont. The protocol will be the basis of the agreement between a licensed practitioner and a licensed pharmacist, says Tarallo. The protocol will include a standard informed consent form (to be signed by the woman receiving the emergency contraception), the information needed by the pharmacist before dispensing the medicine, referral information, counseling information, and forms and documentation. Prior to initiating practice under a collaborative practice agreement, H.237 also requires that a pharmacist complete an approved training program, says Tarallo.

PPNNE and EC coalition partners will help develop and provide training to pharmacists in Vermont who wish to provide EC under the collaborative practice agreement, Tarallo says. Coalition partners such as the Vermont Network Against Domestic Violence and Sexual Assault in Montpelier will play an important role in training pharmacists to screen and care for victims of sexual assault and abuse, says Tarallo.

Legislation in play

Lawmakers in Colorado, New York, Illinois, Kentucky, and Maryland all have introduced legislation this year on pharmacy access to EC through some form of collaborative agreement with a collaborating medical provider, reports Nicole Monastersky, spokeswoman for the Oakland, CA-based Pharmacy Access Partnership, an advocacy organization. Legislators in New Jersey and Vermont also have introduced similar legislation, she notes. (Pharmacy Access Partnership launched a dedicated web site,, in September 2003 to keep national audiences informed about EC and pharmacy access on a state-by-state basis. Click on "Legislation" to obtain the latest information on state activity.)

The partnership has made an investment in promoting expanded access to EC at the state and national levels, says Monastersky. Through funding from the Menlo Park, CA-based William and Flora Hewlett Foundation, the partnership has created the States Take Action Toward EC Services (STATES) Re-granting Program to provide direct financial support to stimulate EC efforts at the individual state level.

The program awarded seven proposals out of 24 applications from state-level organizations for focused short-term efforts to increase EC commitment of pharmacy stakeholders. Organizations receiving awards include Planned Parenthood of Delaware in Wilmington, Healthy Mothers Healthy Babies Coalition of Hawaii in Honolulu, American Civil Liberties Union of Illinois in Chicago, Pro-Choice Massachusetts Foundation in Boston, American Civil Liberties Union of Mississippi in Jackson, and Planned Parenthood of Northern New England in Williston, VT. These organizations were chosen because they either clearly identified their potential to effectively leverage momentum achieved by current or past state-level activity, or they demonstrated that they would initiate new engagement among a cross-section of stakeholders in states where little activity has occurred, says Monastersky.

Wal-Mart to carry EC

Good news for your patients who get EC prescriptions filled at off-site pharmacies: Plan B now will be available at Wal-Mart pharmacies. On March 3, the retailer announced that all of its pharmacies will begin carrying the drug, manufactured by Barr Pharmaceuticals in Pomona, NY. The move was scheduled to take place on March 20, according to a company-issued press release.1

Wal-Mart, which operates more than 3,700 pharmacies in the United States, was the country’s only major pharmacy chain not selling Plan B. According to its press release, the company will continue to uphold its conscientious objection policy, which allows any of its pharmacy associates who do not feel comfortable dispensing a prescription to refer customers to another pharmacist or pharmacy.1

Stocking Plan B in Wal-Mart pharmacies is a major step in the right direction to improve women’s access to contraception — particularly EC in pharmacies, says Monastersky. Wal-Mart pharmacies, particularly those in rural and frontier areas, may be the only pharmacy available for miles around, which had created a huge barrier to women seeking Plan B.

"In general, pharmacies are conveniently located and are often open longer hours than physicians’ offices," observes Monastersky. "Offering Plan B in Wal-Mart stores offers increased access for women throughout the country."


  1. Wal-Mart Stores. Wal-Mart to Carry Plan B Emergency Contraception. Press release. March 3, 2006. Accessed at:


To track Wal-Mart’s agreement to stock emergency contraception (EC), EC advocates have developed a "Wal-Mart Action Packet." The packet, designed in conjunction with the fifth anniversary of "Back Up Your Birth Control Day" on March 21, contains a suggested list of questions to ask at a local Wal-Mart pharmacy to determine whether Plan B is stocked at the facility, as well as a tracking form. To download the free packet, visit the Back Up Your Birth Control web site,, and click on "Make sure Wal-Mart keeps its promise."