WHERE THE BOX of emergency contraception was supposed to be, on the shelf of the downtown Portland Rite Aid this September, there was something else instead: a square sign printed with tiny text. The sign said you have to talk to a pharmacist to get Plan B One-Step. It also said you need ID, to show you’re older than 17.
Two things are wrong with this picture.
Since 2009, Plan B, a brand-name emergency contraception that prevents pregnancy if taken within 72 hours after sex, has been an over-the-counter medication. It can be on pharmacy shelves right next to aspirin and cold medicine. And while it was once restricted to being over the counter for women 17 and older, Plan B—as of August 1—is supposed to be available regardless of age.
Which means it’s supposed to be easy to pick up Plan B. But when we secretly shopped for Plan B at six Portland pharmacies in August and September, only two stores actually had the contraceptive available on the shelf. Four stores required patrons to talk to a pharmacist to get the emergency contraception. Additionally, three stores asked for ID.
Keeping Plan B behind the counter is not illegal, since none of the stores required a prescription, but it does create an unfortunate barrier to accessing the medication. Some pharmacies, like Rite Aid, keep the drug at the counter because they’re worried about people stealing the $50 pack of pills.
However, pharmacy counters usually have limited hours, meaning customers may have to wait overnight to pick up Plan B—a big problem when the clock is ticking on the drug’s 72-hour window of effectiveness. Additionally, some women—especially those who are younger than the age of consent—may feel nervous about talking face-to-face with a pharmacist about a drug that’s been at the center of a moral debate. That’s part of why women’s health advocates have fought for more than a decade to make Plan B over the counter for all women.
The battle with the US Food and Drug Administration (FDA) bureaucracy over Plan B has been long and heated. It was first approved as a prescription drug in the United States in 1999. Over the next 10 years, the FDA rejected and stalled requests to make the drug available over the counter. That left women who needed Plan B scrambling to quickly meet with a doctor and get a prescription before they could buy the pills at the drugstore.
Several FDA officials quit in protest of the agency’s handling of Plan B, including its assistant commissioner, Dr. Susan Wood. Wood angrily noted after another federal rejection of the drug’s all-ages, over-the-counter status in 2011 that even Tylenol isn’t safe for all consumers.
“So why are contraceptives singled out every single time when they’re actually far safer than what’s already out there?” she asked.
Finally, a judge ruled this spring that the FDA must make the brand Plan B One-Step available for women of all ages over the counter. It was a major victory for emergency contraceptive access and reproductive rights groups, who excitedly snapped photos of boxes of Plan B as they appeared on drugstore shelves on August 1.
But the survey of Portland pharmacies this August and September revealed that the hard-won policy changes have yet to filter down to all pharmacy shelves. Six volunteers and I shopped for Plan B at Rite Aid, CVS, Safeway, City Target, Fred Meyer, and Walgreens.
The ease of getting Plan B varied greatly. At Walgreens and Fred Meyer, purple boxes of Plan B One-Step were on shelves in the lube and condom aisles. Rite Aid had the small signs directing customers to the pharmacy counter, while Target, Safeway, and CVS had no signs—customers had to know to ask for the drug at the pharmacy counter. At Southeast Portland Rite Aid and Safeway locations and a Northeast Portland Fred Meyer, volunteer shoppers report being asked for ID, which should not be necessary now that the drug is available to women of all ages.
When volunteer Hannah Strom looked for Plan B at the Northwest Portland CVS in mid-September, the pharmacist told her they were out because the drug was still being re-labeled—other pharmacies didn’t have that problem.
I returned to the downtown Rite Aid in early October to see if anything had changed. Now, Plan B was sitting on the shelf in a locked box. But right next to the locked package was the sign saying the drug is only available at the counter for women over age 17. What should be a simple transaction is still sadly confusing.
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This story is part of the Reproductive Justice Reporting Project, an initiative of the Media Consortium in partnership with the Association of Alternative Newsmedia, made possible with a grant from the Quixote Foundation.
Interesting article, though not too surprising. Another ridiculous obstacle only briefly touched on in the article is the cost. It’s true, if you go through the obigatory interrogation by the pharmacist and show your ID (in which your name is then recorded) you are asked for $50.00. FOR A SINGLE PILL. To be sure, levonorgestrel, a synthetic progesterone which is the active ingredient in Plan B, many oral contraceptive pills and the IUD Mirena, is relatively cheap. Pharmaceutical companies can churn out bricks of the stuff for pennies.
Of course cost is probably the best deterrent for the group of people who are most likely to benefit from emergency contraception–underage, poor, single and marginalized.
I bring this up for the irony of my own experience with Plan B. I am a middle aged, professional, married white guy (who has extensive knowledge of contraception through his job) who was on vacation in the early part of the summer in Southern California with my wife. We have no children and have used all kinds of contraception from “the rhythm method” and “spray and pray” to condoms, ocps and IUDs. After my wife, who is in her mid-thirtes, decided to quit all the hormone choices (and I in the contemplation phase of a vasectomy) we were cruising along without a “net” (admittedly half-heartedly hoping for a baby). One night, after drinks with friends on the beach we a shared a night of wild abandon. Upon awakening I did some fuzzy calculations in my head and realized that my wife was probably ovulating (which I also thought was partially responsible for the “wild abandon” part of our night). After some contemplative conversation over coffee in the morning we decided it would best to go ahead and try Plan B. She had never taken it before.
California also has Plan-B over the counter and so I ran into a Walgreen’s to pick it up. But, it was not really “over the counter” and, as the article describes it, I was directed to the pharmacy counter. I waited in line and asked the pharmacy tech for Plan B. With a raised eye she stated that she had to get the pharmacist who asked me one, if it was for me and two, if I had ID. I explained that it was for my wife and he filled out the form with my driver’s license and then said, “That’ll be $50.00.” Now, having worked for years at community health clinics and given out mountains of contraception, I was agog. I can certainly afford Plan-B but I’ll be goddamned if I am going to give Walgreen’s or TEVA/Women’s Health a fucking penny out of principle (I thought to myself $20.00 seemed reasonable as that was the price of the bottle of wine that contributed to the lapse in judgement). Keeping the 72-120 hour window in mind I literally drove to a community health clinic I used to work at in Northern California and got Plan-B from an old colleague.
Here in Portland the access to Plan B through our local pharmacies is probably easier than say in a place like John Day or Tillamook. Imagine the obstacles for a 16 year old girl with little money, less understanding parents and needing emergency contraception–50 bucks is a lot for someone like her and, notably, a lot less than an abortion or the lifetime cost of an unwanted child for society. The pharmacies in Oregon need to ADHERE TO THE LAW, have the stuff on the shelf and price it reasonably. Far more people become seriously ill and/or die from Tylenol than hormonal contraceptives so it’s obviously not an issue of health or safety but a political one.
To all those needing Plan-B do not forget about Planned Parenthood–it’s great organization (though admittedly not everywhere particularly in rural areas) and can provide contraception, emergency contraception and many other resources for sexual health at a much reduced cost for most people. Thank you Sarah for the insightful article.
You can walk into any pharmacy in British Columbia and ask the pharmacist for AC&C, (Aspirin Caffeine, & Codeine) and the only question they ask you is how big a bottle you want. Here, you ought to be using herbs, anyway.