Despite victories, obstacles to emergency contraception still exist

August 1 has become an important anniversary in the fight for access to reproductive health care.  Last August 1, we celebrated the emergency contraceptive pill, Plan B One-Step, arriving on store shelves.  And two years ago we cheered as regulations went into effect guaranteeing no-cost coverage for prescribed contraceptives in most insurance plans. 

Unfortunately, the recent Hobby Lobby decision by the Supreme Court has the potential to roll back these victories and is a vivid reminder that no right stays won without a fight.  As long as people like the owners of Hobby Lobby continue to interfere with our personal health decisions, we will have unfinished business in ensuring access to affordable reproductive health care.

In Hobby Lobby, the Court ruled that closely-held for-profit corporations can object to covering health services in their employee insurance plans based on the owners’ religious beliefs– even when those beliefs conflict with scientific evidence.  Thus they can, among other things, opt out of the Affordable Care Act’s requirement that employers cover all FDA-approved forms of contraception with no cost-sharing. 

While it is likely the Obama administration will craft a work-around to ensure the employees of such companies still get coverage for their health needs and some in Congress are trying to pass a Hobby Lobby “fix,” conservatives have responded that the solution is to explore moving birth control over the counter.  

We would certainly applaud efforts to make a daily birth control pill easier to obtain, but a quick review of the problems women still encounter in obtaining emergency contraception (EC) –which can prevent pregnancy after sex – makes it clear that removing the need for a prescription is not a silver bullet; it is only the first step in providing seamless access to reproductive health care.

The good news is for those who fear their birth control has failed or who have had unprotected sex (perhaps because their method was not covered and they could not afford to pay for it out of pocket), they should be able to find EC on store shelves.  The brand-name version, Plan B One-Step, can be purchased without a prescription by women and men of all ages.  And generic versions – which once required a prescription for people under age 17 – will soon be sold right next to the name brand without a prescription or proof of age needed.  This was not an easy battle - it took over a decade of advocacy to get even this far.

Unfortunately, the price of EC is still cost-prohibitive for many.   Plan B One-Step averages about $48 per dose while in-store generics are only a few dollars less.  The newly-approved AfterPill is another generic that is priced more affordably at $20 per dose.  However, it is only available online and, unbelievably, the site does not offer expedited shipping.  EC is a time-sensitive product and is more effective the sooner it is taken, ideally within 72 hours of unprotected intercourse.   Thus, AfterPill might be a viable option only for those who want to have EC on hand well in advance of when they might need it.

The other bad news is that retailers are not always stocking EC appropriately – whether due to ignorance, confusion, fear of theft, or moral objections.  An April 2014 study showed that only half the stores sampled carried Plan B One-Step on the shelf.   Some stores still directed consumers to the pharmacy counter, and in stores where it could be found in the aisles, many locked the product in a box or case that required store assistance to open. 

To complicate matters further, although the FDA has approved generic EC pills for sale to all ages without a prescription, the label must carry a misleading recommendation that they are not intended for use under age 17.  However, politics and money, not the health and safety of young women, are the reasons for this unnecessary warning.  Some states have also tried to reverse course by passing laws that would reinstate age limits on EC pills.

Finally, for people whose insurance plans cover contraception at no cost, that coverage only applies to prescribed contraceptives.  While this can include over-the-counter products for which someone took the time to get a prescription, that extra step undermines the convenience factor of having a time-sensitive medication like EC on store shelves in the first place. 

The bottom line: even though August 1 is a good time to celebrate our victories, we cannot rest on our laurels. The Hobby Lobby ruling underscores the obstacles left to overcome and the vigilance required to ensure that by this time next year, we have made even more progress in the effort to secure greater access to all forms of contraception.

Arons is president and CEO of the Reproductive Health Technologies Project (RHTP), a non-profit organization that seeks to change the political and commercial climate in the United States regarding women's reproductive healthcare.

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