Pharmacies May Thwart Patients' Efforts to Get Plan B


SAN FRANCISCO — Emergency contraception is available in 69% of Los Angeles pharmacies, and patients usually receive accurate information when inquiring about it, according to a study using sham patients.

However, in one-third of encounters in the study, the patients received the information only after multiple calls and multiple recitations of their situation, Dr. Anita L. Nelson said at a conference on contraceptive technology sponsored by Contemporary Forums.

Some pharmacies provided inaccurate information. For example, of 1,206 pharmacies contacted, 74 (6%) referred the woman to her clinician for a prescription. Another 12 pharmacies (1%) said that they knew that emergency contraception was available without a prescription, but that nevertheless they required women of any age to have a prescription.

At the time of the study, Plan B was available without a prescription to women aged 18 years and older. Recently, however, a U.S. federal judge ordered the Food and Drug Administration to make the emergency contraceptive Plan B (levonorgestrel) available to 17- year-olds without a prescription within 30 days, and the FDA complied.

Dr. Nelson and Dr. Cindy M. Jaime of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., conducted the study between October 2007 and October 2008. They attempted to contact all 1,440 unduplicated telephone numbers for pharmacies listed in the Yellow Pages for Los Angeles County; many of the phone numbers had been disconnected or were numbers for businesses selling medical marijuana or herbal remedies (Contraception 2009;79:206–10).

Female interviewers were trained to speak hesitantly to the person who answered and to say that she and her boyfriend had had sex the day before and that he had just told her that he had not used a condom. She then said that she had heard that maybe there was something she could take to keep from getting pregnant, and asked the person on the telephone if he or she knew about this.

Of the 1,206 pharmacies the investigators were able to contact, 835 (69%) responded that they carried emergency contraception and had it available on site without a prescription. An additional 232 (19%) responded that they did not have it in stock or did not carry it themselves but referred the caller to other pharmacies. Only 15% of those referrals, however, were to a specific local pharmacy. More commonly, the caller was referred to “any pharmacy” or to specific chains.

“What was very heartening is that when we finally got through to somebody, most of them gave very accurate information,” Dr. Nelson said. Beyond that, some pharmacies responded in ways that Dr. Nelson described as “inspiring” and “heartwarming.” For example, one person said, “We were going to close in about 10 minutes, but if you can get down here, I'll stay open for you.”

But then there were the people who responded by telling the caller: “You need a doctor first to get a prescription for those pills,” or “You could have a beautiful baby.” Other comments included: “Next time be more careful,” “Why are you not on the birth control pill?” and “Did you really have sex without a condom?”

Others provided inaccurate information. Plan B is most effective when taken within 72 hours after unprotected intercourse. However, three pharmacies said that emergency contraception had to be taken within 12 hours, three said 24 hours, and six said 48 hours. One pharmacy said that it was too early for the caller to use Plan B— that the pills needed to be taken 2–3 days after intercourse.

One pharmacist said that Plan B used to be available over the counter but was not any more, and two said that the person needed to be at least 21 years old to receive it.

Seventeen pharmacists hung up the phone after hearing the caller's question, and several hung up repeatedly upon being called back. Others asked overly personal questions such as “Are you married or single?” or “How long have you known him?”

As much as 29% of the time the women first spoke to a person who was not able to answer very basic questions, suggesting that pharmacies need to bolster their training of staff members. Dr. Nelson urged clinicians to consider prescribing emergency contraception in advance of need.

She stated that the study received no outside funding and disclosed that she has served on advisory boards and speakers bureaus, and has received research funding from, Duramed/Barr Pharmaceuticals Inc., which manufactures Plan B.

Contemporary Forums and this news organization are owned by Elsevier.

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