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Behind-the-counter status for a medication allows individuals aged 18 or older to purchase the medication without a prescription. Investigators sought to determine whether the 2006 FDA behind-the-counter approval for Plan B emergency contraception resulted in improved access to the agent. The survey asked whether pharmacies were able to provide Plan B within 24 hours, and, if not, why not (i.e., not carried and therefore not available within 24 hours or refusal to provide Plan B at all). Pharmacists also were asked about the price of Plan B. All pharmacies in Boston, Atlanta, and Philadelphia were surveyed in 2005 and again in 2007; overall response rates were 75% and 82%, respectively.
In 2005, 22% of pharmacies were unable to provide Plan B within 24 hours, compared with 8% of pharmacies in 2007. Inability to dispense Plan B occurred most commonly because the product was not carried. Rates of refusal to provide Plan B dropped from 4% in 2005 to 2% in 2007. Large pharmacy chains were substantially more likely than small chains to stock the product; in 2007, only 3% of large chains could not provide the medication within 24 hours. The reported cost of Plan B varied from US$18 to $80 (mean cost, $43).
Gee RE et al. Behind-the-counter status and availability of emergency contraception. Am J Obstet Gynecol 2008 Nov; 199:478.e1. (http://dx.doi.org/10.1016/j.ajog.2008.04.032)
Comment
Access to Plan B seems to have improved now that the medication has been granted behind-the-counter status. One weakness of this study is its focus on large metropolitan areas; whether the findings would differ in smaller cities and rural areas is unknown. Nonetheless, these results highlight important, practical aspects of Plan B availability. Clinicians should know which local small pharmacies stock Plan B so that patients who require this agent can be directed either to them or to larger chains. Given that the cost of Plan B varies widely, advising patients that they should call ahead to check the price not only could save money but also could help lower the risk that women will not use Plan B because of financial considerations. Some women aged 18 or older might prefer prescriptions, which could be associated with lower out-of-pocket costs; for women younger than 18, Plan B is available only by prescription.