About 'Plan B'

Post staff writer January Payne was online Tuesday, Nov. 21 at 2 p.m. to discuss the over-the-counter sale of the "Plan B" pill.

A transcript follows.

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January Payne: Thanks for joining me today to discuss Plan B, the "morning-after" pill that is now -- or will soon be -- available over the counter (OTC) at pharmacies nationwide. Plan B is a form of emergency contraception that, if taken within 72 hours of unprotected sex, can prevent pregnancy.

There has been much political debate about this medication being made available OTC. The Food and Drug Administration decided in August to make Plan B available OTC to anyone -- male or female -- ages 18 and older. Teens and girls younger than 18 still need a doctor's prescription to buy Plan B.

My story in today's paper focuses mostly on medical and practical questions/concerns raised by consumers in recent months, since the FDA's August announcement. The story does not address political concerns -- such as whether or not Plan B should be sold OTC to anyone, girls under 18 included, which is a hot topic that has been the source of intense debate. I will try to stay away from those hot-button political issues in today's chat as well but am happy to answer any medical or practical questions/concerns you might have. That said, please fire away!

For Plan B, A Broader Reach (Post, Nov. 21)

Is Plan B Unsafe? (Post, Sept. 6, 2005)

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Virginia: "It's not known yet whether or not insurance companies will cover costs for the drug." Is anyone getting on the insurance companies to cover this? Abortion is covered by health insurance and this $35 cost is a lot less expensive emotionally and financially. Why is everything so backward?

January Payne: Some of the sources I spoke to seemed to think that insurance companies may not cover the OTC version of Plan B, based on similar experiences when Claritin was made available OTC. But this is one of those things where time will tell.

And it may end up varying from insurance company to insurance company -- The fact that some insurers don't currently cover regular birth control (such as the Pill, patch, etc.) -- while others do -- is an example.

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Bethesda, Md.: Why are you abetting providing Plan B to minors without physician prescription, when it is known that interfering with ovulation of a girl whose ovulations have not yet become regularly established (this can be up to five years after first menses), can lead to considerable difficulties later which may require much medical treatment? Why subject young women to unnecessary risk, when Plan B can only be of any possible use eight days out of the cycle? If The Post wanted to be responsible and truly serve the public, they would sponsor fertility awareness education for all women to show them how to identify the beginning and end of their fertile times and empower them to make responsible choices about sexual behavior.

January Payne: I'm posting this to show different perspectives on this topic, and will address some points made but not all. The piece is not intended to abet providing the drug to minors without a prescription. Teens/girls under age 18 need a doctor's prescription to buy the drug.

That said, one question that we've heard raised by consumers was if men/family members/boyfriends/husbands/fathers/etc. would be allowed to buy the drug on their own -- whether that be for a teen or a woman 18 or older -- so we answered that question in the story.

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New York, N.Y. : Thank you for your comprehensive look at the issue. It seems that the main hurdle to wider use of Plan B is education: ensuring that women (and couples) know when to use Plan B, how it works and where to get it. Do you know of any efforts by Barr Laboratories or state- or federal-level legislative efforts to educate the public about the importance of emergency contraception as a back-up contraceptive method?

January Payne: I don't know of any government efforts to educate the public but there is a lot of information available online. Here are some links:

FDA

Plan B Web site

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Jim M, Fairfax, Va.: My wife has had history of blood clots due to the Pill. Does this Plan B pill have the same risks associated with it?

January Payne: If your wife has a history of blood clots, she should definitely talk with her doctor before taking Plan B. Blood clots are a known risk of combination (estrogen & progestin) birth control pills; Plan B is a progestin-only formulation with a different risk profile, but it's better for her to check with her doctor to be on the safe side.

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Washington, D.C.: The FDA rejected OTC sales of Plan B for minors because of a lack of research on how the drugs might affect them. It was also concerned about the social impact on minors. It seems irresponsible, then, for you to explain how minors might get their hands on the drug without the supervision of a doctor.

January Payne: Since I've addressed the part of this question that deals with why the question about men/family members/etc., being able to buy Plan B was included in the story, I will focus on the other aspects of this question here.

There were a multitude of reasons for why Plan B's OTC approval was delayed. While some groups, such as the American Association of Pro-Life Obstetricians and Gynecologists and Concerned Women for American, argued that the drug shouldn't be made available OTC for the several reasons including some of the reasons that you describe, other medical groups -- including the American Academy of Pediatrics (AAP) and the American Medical Association -- argued that the drug should be made available OTC. The AAP said in a statement in 2004 that it believed that there was enough safety data to support making the drug available to adolescents as well as adults.

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Pharmacy Access Partnership, Calif.: It is also important to know that, in nine states (AK, CA, HI, ME, MA, NH, NM, WA, VT), women can obtain Plan B directly from a specially trained pharmacist without requiring an advance prescription from a doctor or clinic. This program is called "EC pharmacy access." Participating pharmacists go through a special training program (available online) and work under a protocol with a doctor, the State Board of Pharmacy or the State Board of Medicine. Women can find a nearby participating pharmacist by visiting http://www.ec-help.org/ and entering their zip code. In this program, pharmacists initiate the prescription for Plan B, rather than the MD, so women of all ages, including those under 18, can obtain Plan B through pharmacy access. More information is available at http://www.pharmacyaccess.org/.

January Payne: Thanks for raising that point. It wasn't addressed in the story since Maryland, Virginia and the District aren't a part of that program, but it's a good point to raise in this chat.

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Washington, D.C.: Do you have any information on the availability of Plan B in the Washington, D.C. metro area? Will all of the major pharmacies (CVS, Giant, etc.) be carrying it?

January Payne: I did a random survey of six stores last Friday and found that half had the OTC version of Plan B in stock, while three hadn't received it yet. I'm told by that the drug should be available in stores that have pharmacies now or very soon. Some stores may choose not to carry it, so you may want to call around to see if the store you have in mind has it in stock. (And be sure to specify that you want the OTC version of Plan B.)

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Alexandria, Va.: Can I take Plan B if I'm on the Pill (Yasmin) and fail to take it correctly? Or will the hormones in Plan B screw everything up?

January Payne: Yes, you can still take Plan B. But be aware that it may mess with your cycle -- meaning you may experience irregular bleeding. Other more specific questions can be answered by your doctor.

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Washington, D.C.: Do you know what date exactly that Plan B will be available OTC?

January Payne: It should be available now, though not all stores have it in stock yet, so it's best to call ahead when in doubt.

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Washington, D.C.: Does Plan B prevent conception or prevent implantation? I've heard it both ways.

January Payne: Plan B works primarily by preventing the release of an egg from the ovary and may also prevent the process of fertilization, according to the FDA. The FDA also reports that Plan B may prevent implantation -- that is, the drug may keep a fertilized egg from attaching itself to the womb.

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Foggy Bottom:"American Association of Pro-Life Obstetricians and Gynecologists and Concerned Women for American"

So much for avoiding politics...

January Payne: Simply trying to present both sides of the issue, so it's only fair to name the groups that were opposed to OTC sale of Plan B.

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Arlington, Va. : Some say that the Bush Administration purposely delayed this drug from coming to market because of moral -- not medical -- concerns. Is there any investigation into this?

January Payne: This is a source of major political debate, but because there was recent news on this front, I'll answer.

There was some semi-related news earlier this month, when a federal judge ruled that the Center for Reproductive Rights (a reproductive rights group) may subpoena over three years worth of Plan B-related White House communications documents, including e-mails, letters, etc.

The group sued the FDA in an effort to get the age restrictions on OTC Plan B lifted and says it wants these documents to figure out if the White House interfered with the FDA's handling of the drug's OTC application.

Group Can Seek White House, FDA Records About Plan B Pill (Post, Nov. 9)

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Woodbridge, Va.: I took issue with one line in the article, "Every woman with a functioning uterus should have this in her medicine cabinet". Having a history of hormonally induced breast cancer and clotting issues in my family, this would not be appropriate for me or any other woman in my situation (also I'm Catholic and the idea of the purpose behind this pill is abhorrent to me.) I think this statement is irresponsible since it doesn't take into consideration that a uterus is not the only part of a woman.

January Payne: You're correct in that every woman/patient is different and needs to take his/her own medical conditions into account. That particular statement was actually a direct quote from a doctor in reference to who Plan B is intended for. That section of the story also contains additional context, including explaining that Plan B is intended for women of childbearing age who also want a backup method of contraception.

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Washington, D.C.: I think it was mentioned in the article that women should buy Plan B and keep it in their medicine cabinet -- so there's no crisis run to the pharmacy. How long is the shelf life?

January Payne: The shelf life is about four years, according to the manufacturer.

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Re: Insurance coverage.: If you truly cannot afford the $35 dollars and have access to a physician or other health care provider with prescription-writing authority, you can ask them to write you a prescription for one pack of birth control pills and for instructions on the Yuzpe Regimen (basically, how many pills out of the pack to take). Yuzpe is essentially the same as Plan B, just not packaged as well.

Also, for a previous poster, many insurance plans do not cover abortions. In some states, the state legislature has forbidden public employee insurance from covering the procedure. Additionally, many states Medicaid coverage will not pay for the procedure.

January Payne: I've heard of instances where doctors prescribe other types of birth control pills when Plan B isn't available. I'm not familiar with this particular type of pill and would advise that anyone seeking an alternative talk to their doctors to figure out the best route to take. (In other words, don't attempt this on your own.)

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Arlington, Va.: No question, just a commendation: thanks to you and The Post for covering this story objectively and thoroughly. I am especially glad you included the information that men OR women over 18 can buy Plan B OTC. That's essential information. (You may just have saved a life.)

January Payne: Thanks for your comment.

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January Payne: We're out of time. Thanks for a good chat today, everyone. There were a few questions/comments that I didn't get to, and for that I apologize. Thanks for reading -- and for writing! Take care.

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