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For Plan B, A Broader Reach
'Morning After' Pill Goes on Sale OTC

By January W. Payne
Washington Post Staff Writer
Tuesday, November 21, 2006

Three months after the Food and Drug Administration decided that emergency contraception should be available to women 18 and older without a doctor's prescription, the over-the-counter version of Plan B -- the "morning after" pill -- began appearing in drugstores nationwide last week. Manufacturer Barr Pharmaceuticals shipped the drug after repackaging it to meet federal labeling rules for OTC medications, but as of Friday, some Washington-area stores had yet to receive it.

The idea of making Plan B available over-the-counter prompted more than two years of political debate, much of which focused on objections to selling the drug to minors. The FDA's August ruling settled that issue for now, but it sparked others. Here are answers to some of the most common questions about the product and its new status:

What is Plan B? Plan B, approved as a prescription drug in 1999, is a backup birth control method that consists of two high-dose pills of the hormone progestin, which has been used in birth control pills for more than 35 years. The medication reduces the risk of pregnancy by 89 percent if taken as directed, according to Barr. Plan B "acts primarily by stopping the release of an egg from the ovary," according to the FDA. "It may also prevent the union of sperm and egg," a process known as fertilization. Even if fertilization occurs, Plan B "may prevent a fertilized egg from attaching to the womb," which is known as implantation. Plan B will not work if the egg is implanted before the drug is taken, the FDA reports.

How soon do I need to take Plan B for it to be effective? Barr advises that women take one tablet within 72 hours of unprotected sex, followed by the second pill 12 hours later. But some studies show that it may be more effective to take both pills at the same time, said Scott Spear, associate professor of pediatrics at the University of Wisconsin at Madison and a member of Planned Parenthood's national medical committee. The studies "found it was a little more effective" to take the two pills together, which may be because "you're less likely to forget and . . . also likely to take it a little bit earlier."

Where is Plan B available? The medication should be available -- now or soon -- at pharmacy counters and clinics nationwide. The corporate headquarters of CVS, Rite Aid, Target and Wal-Mart all reported receiving the drug. Unlike many other OTC medications, it will not be sold at gas stations and convenience stores.

For whom is it intended? Plan B is recommended for any woman of childbearing age who has unprotected sex and wants a backup method of contraception. "Every woman with a functioning uterus should have it in her medicine cabinet," Spear said. "You don't want to have to go out and look for it [under time pressure] when you need it."

Doctors emphasize, however, that Plan B is not meant to be used as a substitute for primary birth control methods -- such as condoms, birth control pills, the birth control patch or vaginal ring. Also, Plan B does not protect against sexually transmitted diseases.

If I buy it now just to have it on hand, how long will it stay effective? The drug's shelf life is about four years, Barr said.

How much does Plan B cost? Will my insurance cover it? Barr sells Plan B to pharmacy chains, distributors, wholesalers and clinics for $27.95. Stores generally set prices higher. Wal-Mart, for instance, sells Plan B for about $35; CVS sells the drug for $44.99. It's not yet known whether insurance companies will pay for OTC purchases of Plan B.

Is Plan B safe? Studies show that Plan B is safe and effective. Some women will experience "non-serious side effects, such as nausea, stomach pain, headache, dizziness or breast tenderness," which are similar to side effects associated with regular birth control pills, according to the FDA. There is no limit to how often a woman can safely use the medication.

Can a pharmacist refuse to dispense Plan B, citing religious reasons? In some places, yes. Pharmacists have refused to dispense prescription versions of Plan B in the past -- and that may also be true with OTC sales of the drug. Wal-Mart, for example, says it will continue its "conscientious objection policy" except in states where it would be prohibited by law. (Maryland, Virginia and the District do not have such laws, according to the National Conference of State Legislatures.) The policy permits any pharmacy employee "who does not feel comfortable dispensing the product to refer customers to another pharmacist, pharmacy associate or store sales associate to complete the sale," e-mailed Kevin Gardner, a Wal-Mart spokesman. The potential for such sales complications is one reason doctors recommend that women not wait for an emergency to buy Plan B.

Is there any way I can legally buy Plan B if I'm under 18? Can my boyfriend, husband, family member or friend buy Plan B for me? Girls younger than 18 need a doctor's prescription. However, anyone 18 or older -- male or female -- can buy the OTC product. You may need to show identification to a pharmacist or clinic staff member to verify your age. Store personnel won't keep a record of your personal information.

What is the difference between Plan B and RU-486? Plan B is not effective if a woman is already pregnant, according to Barr, whereas RU-486, available only by prescription, is intended to induce abortion.

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