Emergency Contraception: What Good Is "Available" If It's Not Affordable?

You've probably seen the tag line for Plan B emergency contraception (EC): Because the unexpected happens. Well, what women may find even more unexpected is that the morning-after pill can still cost up to $70! These are hard economic times and, even for a gal with a credit card, that's a tough pill to swallow.

Thanks to the determined efforts of women's reproductive health advocates, Plan B was finally approved by the FDA for nonprescription sale to women 18 and older on August 24, 2006.  Unfortunately, this hard won victory was less sweet because of the vulnerable populations of women it left out in the cold: minors, undocumented women who cannot produce a government-issued ID to prove their age, and low-income women who cannot afford the cost or whose Medicaid coverage requires a prescription.

It's not rocket science: when a drug's effectiveness is tied to a 72 hour window, the few hours or days it can take to get a doctor's prescription has real consequences. And the price -- on average $40 or more -- forces low-income women to make a difficult choice and possibly take a real gamble.  After all, EC is a preventative measure and the federal minimum wage is about $290 a week.  Would you pay such a large chunk of your paycheck out-of-pocket if you weren’t even sure you were pregnant?

So how can we lower the cost of EC and increase access to more women? First, more states need to expand their Medicaid coverage to include over-the-counter (OTC) emergency contraception. According to the National Institute of Reproductive Health, eight states have changed their policies to include OTC EC, some even using state dollars to cover the cost. Here's hoping more states will follow in their footsteps. Wouldn't it be nice if low-income women didn't always have to take it on the chin in reproductive health so a few politicians could feel morally righteous by creating obstacles to family planning services?

Second, the FDA needs to stop buckling to peer pressure. On April 22, 2009, the FDA announced that it would lower the age requirement of men and women who can purchase EC over-the-counter to 17.  This announcement came after a U.S. District Court found the FDA guilty of caving to political pressure from the Bush administration in 2006 by imposing an age restriction on EC without any medical basis. Fortunately, nine states have passed legislation that allow pharmacists to write a prescription for EC and dispense it, saving critical time for minors and undocumented women. Hopefully more states will adopt similar legislation -- or the FDA will grow a pair.

Finally, variety is the spice of life. In the United States, there are only three emergency contraception pills on the market: Plan B, Plan B One-Step (which will eventually replace Plan B altogether), and Next Choice, an FDA approved generic brand of EC. What the market needs is a little healthy competition. The FDA should create incentives for other drug companies to produce and sell their own version of EC.  If more versions of EC existed, it would force companies to offer competitive prices to stay in the game.

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