By Rebecca Bowers

EXECUTIVE SUMMARY

According to a new national survey, less than 10% of pharmacies have the ability to fill a prescription immediately for ulipristal acetate, the prescription-only form of emergency contraception (EC).

  • About 70% of pharmacies without immediate availability said they could order the drug, with a median predicted wait time of 24 hours.
  • Less than 65% of pharmacies could indicate correctly a difference between ulipristal acetate and levonorgestrel forms of EC; just half of the pharmacies surveyed could identify that ulipristal acetate can be taken up to 120 hours after unprotected sex.

According to a new national survey, less than 10% of pharmacies have the ability to fill a prescription immediately for ulipristal acetate, the prescription-only form of emergency contraception (EC).1

Ulipristal acetate (ella) was approved for use as an emergency contraceptive by the Food and Drug Administration (FDA) in August 2010. It follows the copper-T intrauterine device (IUD) as the most effective option for EC; less than one in 1,000 women who have unprotected sex and use the copper-T IUD for EC become pregnant, compared to five in 1,000 women who choose ulipristal acetate. About 10 women out of 1,000 who choose levonorgestrel-only EC are estimated to become pregnant.2

To conduct the current study, researchers at the University of Hawaii at Manoa used a telephone-based secret shopper survey of 533 retail pharmacies from 10 large cities in five U.S. geographic regions. During the 2016 survey, callers identified themselves as uninsured 18-year-old women attempting to fill prescriptions for ulipristal acetate, with inquiries regarding availability and use of the drug.

Thirty-three of the 344 pharmacies indicated the ability to fill a ulipristal acetate prescription immediately. About 70% (224/311) of pharmacies without immediate availability said they could order the drug, with a median predicted wait time of 24 hours.1 Less than 65% of pharmacies could indicate correctly a difference between ulipristal acetate and levonorgestrel forms of EC; just half of the pharmacies surveyed could identify that ulipristal acetate can be taken up to 120 hours after unprotected sex.1

Ulipristal acetate is available in many European countries without a prescription, notes Andrew Kaunitz, MD, University of Florida Term Professor and Associate Chairman of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine-Jacksonville. For women who may benefit from EC, particularly those using short-acting or less effective contraceptives, clinicians may wish to prescribe ulipristal acetate in advance of need, he suggests.

How About Levonorgestrel EC?

Although levonorgestrel emergency contraception (sold as Plan B One-Step and in some generic forms as Aftera and My Way) is approved for over-the-counter (OTC) sale, true OTC access is not a reality for many women, according to a new survey conducted by the American Society for Emergency Contraception, a Princeton, NJ-based nonprofit advocacy group.

In conducting its third survey since 2014, Society members visited retail pharmacies across the United States to determine whether levonorgestrel EC was stocked on store shelves as allowed by FDA regulations, how much it cost, and whether pharmacy staff were imposing age restrictions, which were removed by the FDA in 2013.

The survey findings indicate that in 40% of stores, levonorgestrel EC is not stocked on the shelf. Independent pharmacies were far more likely than chain stores (91% vs. 24%) to keep levonorgestrel EC behind the counter, rather than to stock it on the shelf. About one-third (30%) of stores continue to call for age restriction and identification requirement on the sale of levonorgestrel EC, even though such barriers were removed in 2013. Data show the average price for the branded product, Plan B One-Step, was about $49, with generic products priced around $39.3

Emergency contraception is more effective the sooner it is taken, so any barriers represent a greater risk of pregnancy, notes Kelly Cleland, MPA, MPH, executive director of the American Society for Emergency Contraception.

“People who need EC may be intimidated or embarrassed to discuss their purchase with pharmacy staff,” said Cleland in a press statement. “There’s no medical reason for EC to sit behind the counter where it remains out of reach of many who need it.”

Although the Affordable Care Act has increased the number of women who can access prescription contraception without cost sharing, most insurance plans require a prescription to cover over-the-counter EC. About 12.8 million women (13%) ages 19-64 years were uninsured in 2014, including low-income women in states where Medicaid has not been expanded.4

“The high price of EC puts it out of reach for many women, for whom $40 or $50 is a significant expense,” said Cleland. “Women who are young, poor, or living in rural areas are among the hardest hit.”

There are no age or point-of-sale restrictions on the purchase of levonorgestrel EC. Any woman or man of any age can purchase such products without needing to show identification, and there is no limit on the number of packages that a person can purchase.

REFERENCES

  1. Shigesato M, Elia J, Tschann M, et al. Pharmacy access to ulipristal acetate in major cities throughout the United States. Contraception 2018;97:264-269.
  2. Paling J. Strategies to help patients understand risks. BMJ 2003;327:745-748.
  3. American Society for Emergency Contraception. Not There Yet: ASEC’s 2017 EC Access Study. Available at: https://bit.ly/2qqH6Gw. Accessed April 17, 2018.
  4. Committee on Health Care for Underserved Women. Committee Opinion No 707: Access to Emergency Contraception. Obstet Gynecol 2017;130:e48-e52.