EXECUTIVE SUMMARY

While age restrictions on levonorgestrel emergency contraceptive pills (ECPs) were removed in 2013, access to pills often is tricky, even for college-age students. Now Stanford University and University of California locations in Santa Barbara and Davis are among the latest campuses that have installed vending machines stocked with ECPs.

  • Colleges and universities have received requests for vending machine ECPs because some student health centers are closed on the weekend and nearby pharmacies may not offer 24/7 access.
  • According to the American College Health Association’s most recent data, 17.8% (male: 14.8%; female: 19.1%) of sexually active undergraduate college students reported use or partner use of ECPs within the past 12 months.

While age restrictions on levonorgestrel emergency contraceptive pills (ECPs) were removed in 2013, access to pills is often tricky, even for college-age students. Now, Stanford University and University of California locations in Santa Barbara and Davis are among the latest campuses that have installed vending machines stocked with ECPs.

The idea to make ECPs available from vending machines on college campuses is not new. In 2010, Shippensburg University in Pennsylvania began making EC available though a vending machine inside the student health center. University officials installed the machine after a student survey indicated 85% of respondents supported such accessibility. Since the machine is inside the health center, it is accessible only to students and employees.

What legal issues, if any, may arise from the availability of ECPs on college campuses via vending machines? According to Michelle Mello, PhD, JD, professor of law at Stanford Law School and professor of health research and policy at Stanford School of Medicine, liability risk is “vanishingly small,” and is outweighed by the benefits of having ready access to emergency contraception.

“Anytime a consumer buys a drug over the counter, rather than with a doctor’s prescription, there’s a risk that because she’s not getting counseling about the drug, she won’t have as good an understanding of the dosing instructions or side effects,” said Mello in a statement. “But vendors aren’t likely to be held responsible for that.”

The Need Is Real

According to Rachel Mack, interim director of marketing and communications
at the American College Health Association (ACHA), 17.8% (male: 14.8%; female: 19.1%) of sexually active undergraduate college students reported use or partner use of emergency contraception (“morning after pill”) within the past 12 months in the organization’s most recent survey. Students who responded “not sexually active” were excluded from the analysis.

According to results from ACHA’s most recent survey, performed in 2014, the contraceptive methods that were most commonly listed as being prescribed at health centers were oral contraceptives (97.2%), the ring (95.8%), the shot (94.2%), the patch (86.7%), and emergency contraception (82.2%).1 About 72% (96 schools) of the 133 schools that answered the question, “Does your health center prescribe, dispense, administer or refer for any of the following contraceptive methods?” reported dispensing emergency contraception, while 82.2% (111 schools of 135) said they prescribed EC, said Mack.

Why Vending Machines?

Colleges and universities have received requests for vending machine ECPs because some student health centers are closed on the weekend and nearby pharmacies may not offer 24/7 access. Dartmouth College in Hanover, NH, offers ECPs and a small selection of non-prescription drugs and health supplies, such as cold medicines, condoms, thermometers, and lip balm, at its student health center, while Pomona College in Claremont, CA, stocks a machine with condoms, ECPs, and a large selection of general health products at its student health services’ wellness room.

Despite policy changes that started in 2013 and were intended to improve access to EC, there still are persistent barriers
to access. Restrictions on generic forms of EC were removed in 2014. However, packaging still had to include a “use recommendation” that mentioned the intended users were limited to women 17 years of age or older.The use recommendation, while not enforceable, was related to Frazer, PA-based Teva Women’s Health’s patent on Plan B One-Step, the initial levonorgestrel EC pill. This recommendation was removed in 2016 when the market exclusivity for Plan B One-Step expired.

Data from a 2016 published analysis of an online questionnaire gathered via an EC-focused listserv for reproductive health professionals indicate that changes in the regulatory status of emergency contraception have resulted in widespread confusion about how it may be sold.2

Respondents indicated that a majority (65%) stocked emergency contraception on over-the-counter shelves, although only 22% of these displayed it without a locked security enclosure. Chain pharmacies were more likely to to stock EC on shelves than were independent pharmacies (77% vs. 5%; P = 0.000), but there was variation among stores in the same chain. Among stores that were checked, 40% incorrectly reported an age restriction for non-prescription purchase of emergency contraception, while 95% correctly stated that men can buy ECPs. The average price for brand LNG EC was $49.64 and for generic LNG EC was $40.05.2

In a more recent study, which used female mystery callers to contact pharmacies in Nashville, Philadelphia, Cleveland, Austin, and Portland, correct information about over-the-counter access was provided only 51.6% of the time. Accuracy did not differ according to the pharmacy’s neighborhood income (47.9% vs. 55.3%, adjusted OR 0.89; 95% confidence interval [CI], 0.71–1.11) and was not significantly different from 2012 (P = 0.37).3

A new website and app, Nurx (www.Nurx.com), is looking to change the game in delivery of not just emergency contraception, but other forms of hormonal contraception as well. Women in Texas, California, New York, Washington, Pennsylvania, Illinois, Virginia, Florida, Indiana, Massachusetts, New Jersey, Michigan, Missouri, Minnesota, and the District of Columbia now can communicate with a healthcare provider online and have prescriptions ordered and delivered to their homes. The company is partnering with licensed medical providers and pharmacies in hopes of expanding the program to other states.

REFERENCES

  1. American College Health Association. ACHA 2015 Pap and STI Survey. Hanover, MD: American College Health Association; 2016.
  2. Cleland K, Bass J, Doci F, Foster AM. Access to emergency contraception in the over-the-counter era. Womens Health Issues 2016;26:622-627.
  3. Wilkinson TA, Clark P, Rafie S, et al. Access to emergency contraception after removal of age restrictions. Pediatrics 2017; doi:10.1542/peds.2016-4262.