Emergency Contraception Accessibility Limited Even After Restrictions Lifted

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Emergency Contraception Accessibility Limited Even After Restrictions Lifted

Are pharmacy employees fully aware of laws governing dispensing of emergency contraception? A survey of Colorado drugstores suggests they were not shortly after the age restrictions were removed. Here is more information.

AURORA, CO – Pharmacy employees apparently lack understanding of evolving laws affecting emergency contraception accessibility, creating barriers for women who need to use it, according to a survey conducted in Colorado.

In 2013, the Food and Drug Administration removed age restrictions on over-the-counter sales of the levonogestrel drug Plan B. To determine how accessible emergency contraception (EC) really is, researchers at the University of Colorado School of Medicine asked 633 Colorado pharmacies about EC access in 2014.

A report on the results, published in Women's Health Issues, found EC completely accessible to only 23% of those seeking to obtain the product.


The study team used the Little Blue Book 2014 to identify Colorado pharmacies, and then had three researchers call the pharmacies posing as women seeking levonogestrel-only emergency contraception (LNG-EC).

Each pharmacy was asked the following questions:

  • whether they had LNG-EC in stock
  • whether it was located on the shelf or had to be requested from the pharmacy,
  • whether a generic version was available,
  • how much the product cost, and
  • whether any additional documentation -- such as proof of age or a prescription -- was required to purchase the drug.

EC was deemed as being "completely accessible" at a pharmacy if the responding employee reported having it available on store shelves that day for purchase without requiring an ID or prescription.

Study authors note that immediate accessibility is especially important in this case, because EC must be taken within 120 hours of intercourse, with greatest effectiveness within the first 24 hours.

While 87% of pharmacies reported having LNG-EC in stock, the accessibility was much more limited. Of the stores with the drug in stock, 42% reported it was behind the counter and had to be requested from a pharmacy employee, and 56% told the incognito researchers that an ID or prescription was required for purchase.

Low accessibility was especially the case at independent pharmacies, where EC was in stock at only 58% of locations, compared to 90% of chain stores and all 24-hour stores. Complete access also was less likely at the independents, 10%, compared to 25% at chain stores and 15% at 24-hour stores, the researchers report.

Study authors suggest that requiring EC purchasers to request the drug from a pharmacy employee and present additional documentation create potentially substantial barriers, especially for adolescents, because of embarrassment in discussing reproductive healthcare or the lack of requested documents.

They posit that pharmacy employees might have been confused about policies for documentation and behind-the-counter access, especially at the point the survey was conducted. The study notes that the age cutoff for LNG-EC products changed four times before being lifted completely, adding, "Delays in updating store policies or lag in information dissemination may explain the variability in knowledge among pharmacy staff about FDA regulations and requirements."

"Although federal policy restrictions on LNG-EC have been removed, this study demonstrates that retail pharmacy-level policies can still create tangible hindrances in obtaining appropriate health care," the researchers conclude.

Related CE

Emergency Contraception: An Update for Pharmacists

Emergency Contraception: Key Concepts for the Pharmacy Technician

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