Wednesday, October 11, 2006

Plan B Coming to a Pharmacy Near You!

On Friday, Amy (our Duvall Project intern) and I had the pleasure of attending an annual conference in NYC that brings together all the experts and advocates involved in increasing women's access to emergency contraception. Barr Laboratories/Duramed, the maker of emergency contraceptive Plan B, was even there to explain how exactly this medication will be made available in pharmacies as an over-the-counter product.

You may wonder, how on earth can these people talk about emergency contraception ALL DAY? Well, we did. And, we still have so much more to discuss, like how to address additional barriers to Plan B that may come up once Plan B is available over-the-counter (i.e. behind-the-counter) for individuals 18 and older. While there's so much to cover and I'm sure you all are as captivated with the topic of EC as I am, I thought I'd share some of what we talked about. I'm a fan of lists, so here we go:

1. Plan B is expected to be available in pharmacies by mid-November! If you are over 18 years old, you can buy it as long as you have a "government-issued" I.D. You must go to the pharmacy counter to ask for it and be prepared to pay between $30-50. This price may vary in each individual pharmacy or pharmacy chain. Young women under age 18 will still require a prescription to purchase Plan B. It is unclear, at this point, how much this unnecessary, unscientifically-based age restriction will affect a minors' ability to access EC.

2. It will be up to each state to determine whether or not their Medicaid program will continue to cover this "dual label" medication. This may greatly impact low-income women who cannot afford the hefty price for this medication out-of-pocket. As of 2005, Pennsylvania's Medicaid program only covered EC in cases of rape or incest. So, there may not be such a great change in this state--EC was and probably will still be inaccessible to low-income women unless they seek it out at a family planning clinic.

3. States may also try to impose their own regulations on Plan B, disregarding the FDA's recent decision for Plan B and requiring a prescription for all women (again). Plan B's availablity would vary from state to state. If this type of action occurred in Pennsylvania, women in New Jersey or Ohio might be able to buy EC over-the-counter but you couldn't.

It will be very interesting to see how all this unfolds. Advocates are working to anticipate and address these potential barriers and work with pharmacists to ensure that they are getting the education and support they need to make Plan B available to consumers.

Check out a newly improved website on EC and how to get it at not-2-late.com. One important thing to remember about EC is that it's only effective if you use it!

Julie in Philly

10 Comments:

Blogger radar pangaean said...

Good article, but bad example used within it. Any scenario that has Ohio being less dominated by the religious fundamentalists than PA hasn't been paying close attention to Ohio politics lately. The state which recently passed the DOMA is more likely to try to find ways to also ban this pill, not less likely.

Sad, but true.

12:14 PM  
Anonymous paula j said...

I love that I would have to show ID, really. I have to do the same for DayQuil yet I can buy cases of bullets and shot gun shelves off the shelf with no questions asked.
Is it just me?

11:30 PM  
Anonymous The Bidge said...

I'm going to say a few unpopular things.... as usual. Fair warning.

First, on the topic of minors having access to Plan B or any emergency contraception, Julie wrote:

"Young women under age 18 will still require a prescription to purchase Plan B. It is unclear, at this point, how much this unnecessary, unscientifically-based age restriction will affect a minors' ability to access EC."`

Since every state in the Union requires at least one parent to be legally responsible for their minor
children, then it's a purely a legal decision at play here. Nothing irrational, certainly not "unscientifically-based" and in these ever litigious times, wholly sensible and prudent.

Indeed, turn it on its ear and you have parents suing pharmacies (who mean well) by supplying their minor children drugs that the parents had no knowledge of, and those parents are again legally repsonsible. Don't whine about the "unscientificness" without at first considering the laws which we are governed by.

Personally, I don't care if every teen on the planet is having sex. I don't care if someone gets pregnant ever, really. Have sex, get pregnant -- it's supposed to work that way. That's how we keep our species going. But the law is clear in that minors are not legally allowed to make decisions for themselves and that the parents are obliged to make those decisions instead. So don't moan about a law that seems unfair to young women having sex until you consider that many pharmacies are small "mom and pop" shops who cannot afford an angry parent's lawsuit. It's a good provision when you rationally look at it this way. Furthermore, what point is their in undermining the family unit by encouraging a child to sneak behind their parents' backs. Would it not be better to work towards improving communication, especially when a teenaged girl finds herself pregnant and will need all the help and support and (hopefully) love she can get? Is there not any value in family any longer? Who else is supposed to look after you? The gov't? You, the ACLU? Please... For most of us, all we have is family. We should building trust, not barriers.

Second: All legal photo IDs are government-issued in America, whether state, local or Federal. Stop being overly dramatic, please. Or do tell me where a person can buy a non-gov't ID these days. I cannot think of one. Whether IDs are a good idea or not is another topic for another day. "Gov't issued" has no bearing on this discussion and cheapens it wholesale.

Thirdly: Just because someone can biologically have a child doesn't mean they should have one. I know that's an extremely unpopular viewpoint. If you're unable to pay 30 dollars for EC, then why on earth would you want to even risk bringing a child into the world. You couldn't raise it properly and you'd be on "gov't-sponsored" welfare if you did have a child, which arguably should not be a "basic human right" but only used for extreme circumstances when times are rather tough. So, let's not play up the "poor" card either. Poor people are capable of rationality and proper judgment just like those who have money. And our definition of "poor" really needs a serious reconsideration these days, but that is also another topic for another day. We treat our poor citizens much, much better than ever before. Poor people have more alternatives available to them than any "non-poor" citizen. I know this firsthand. My mother is also a nurse. Poor people are NEVER turned away from Emergency Treatment. However, that said, poor people may often find themselves billed for it after the fact. And if a hospital or clinic then decides to turn over the bill to a credit collection agency, then the laws saying that medical bills cannot be counted against your credit rating go right out the window. You could ask my brother, who doesn't have health insurance. He'll get treated, and they'll bill him, and he can't pay it because he's "under-wealthy" and the hospital sells that debt to a collection agency. It's an appalling workaround... But when my brother needs emergency treatment, they still treat him every time. For poor people, there are more "free clinics" today than there were even ten years ago. Poor people have plenty of options if they choose them.

On States' determination of the law's applicability: Brilliant idea. Each state is an independent member of the union, with its own governing members and laws and people. Indeed, every state needs more authority in choosing its own laws, else we risk utter country-wide fascism. The Fed should not be as meddling as it presently is. It wasn't intended to be like this. At the present rate of Federal intrusion into our lives and laws, we might as well simply abolish all States and simply have one huge one instead. Would that better?

All of this said, I'm entirely for EC and Plan B and all of it. It's a choice for both men and women in a world where we are all rapidly having our choices taken away from us.

Consider the above for a while. Then, if you still feel you have a valid argument, by all means have your say. But please open your worldview and consider the consequences of every action. Considering the overall charter of the ACLU, it is beyond compare to forget that Mom and Pop running that pharmacy, a place which helps hundreds of people every day, also need protection from those who would sue them if they did provide drugs to children.

Children cannot buy a lot of things. EC is something that most adults should only buy in an ... Emergency. Children should first seek their parent's help. If the parent's refuse, then the child can try alternative means. But at no time should we ever try to undermine the ability of a family to make decisions for the family, or else we might as well all move to a country that is run by true dictators. There, you would not even have the ability to moan about "gov't-issued" anything, because there wouldn't be anything but gov't-issued punishment.

Perspective, people. Honest perspective. It's addictive when you give it a try. Please do.

I apologize for any and all typos or omissions (which are likely numerous)...

5:57 PM  
Blogger ACLU of Pennsylvania said...

Phew. Where do I begin?

Bidge, you ask for "honest perspective" but I'm not sure what that means. Perspective means viewpoint. I am presenting my viewpoint and the ACLU's stance on these issues, along with some of the knowledge I have acquired by working for the ACLU in a job where nearly 100% of my time is spent examining issues related to reproductive freedom and carrying out programming that addresses these issues. I am being sincere when I write about these things so, in my opinoin, I am presenting "honest perspective." If you're implying that honesty involves sharing the truth which equals one perspective (yours), then "honest perspective" surely doesn't exist. I cannot disagree with you more on many of the points you make.

You also asked for me to sit with your comments before responding. I only wish you did the same before resopnding to my original post. While you have written an impassioned response, I believe some of it was fueled by assumptions or misunderstandings. And, those are the points that I'd like to address.

1. You stated that the FDA's decision to continue requiring a prescription for minors to get EC is "a purely legal decision" and not "irrational, [and] certantly not 'unscientifically-based' . . . in these ever litigous times." When I wrote that the FDA's decision was not based in science, I meant just that. The FDA writes on their website about Barr Laboratories' application for Plan B to be accessible to minors over-the-counter (www.fda.gov/cder/drug/infopage/planBQandA.htm):

"FDA has completed its review. . . and concluded that the application [for OTC access for minors] could not be approved at this time because. . . adequate data were not provided to support a conclusion that young adolescent women can safely use Plan B for emergency contraception without the professional supervision of a licensed practioner."

The FDA also says, "Although the joint committee recommended to the FDA that this product be sold without a prescription, some members of the committee, including the Chair, raised questions concerning whether the actual use data were generalizable to the overall population of nonprescription users, chiefly because of inadequate sampling of younger age groups."

The advisory committee of scientists felt that the research sample was a sufficient representation of younger age groups to conclude that Plan B is not only safe for adult women, but for women of all ages. The FDA did not follow the advisory committee's recommendations. To me (and to scientists), that's not scientifically-based decision-making. And, with the politics surrounding the FDA's consideration of Plan B as an over-the-counter product, at this time we can only speculate what kind of politics were at play with the age-restriction decision. The Center for Reproductive Rights has filed a lawsuit against the FDA regarding the entire Plan B application--to learn more about the politics at play at the FDA, go to www.reproductiverights.org.

2. You make the claim that "the law is clear that minors are not legally allowed to make decisions for themselves and that parents are obliged to make those decisions instead." Note: In the FDA's decision about Plan B, it will be physicians, not parents, who are required to evaluate the safety of Plan B for minors. Additionally, Pennsylvania law has been interpreted to permit healthcare providers to provide confidential contraceptive care to minors upon their own consent. Federal law also guarantees minors access to contraception without parental consent or notification at facilities that receive funding through Title X or if the patient presents a Medicaid card. Because EC is a form of contraception, minors can also consent to its receipt on a confidential basis, i.e. without parental consent and/or knowledge.

3. You bring up a fear that "mom and pop" pharmacies may be sued by an angry parent for dispensing EC to their child. While I'm not a lawyer, and I can certainly check with other folks, I'm pretty sure that the parents would have as much grounds to sue a pharmacy for selling Plan B as they would for selling condoms. Both contraceptives are completely legal for sale. The only way a parent might have grounds is if, under the current FDA decision, the pharmacy did not check ID and dispensed Plan B to a minor who would have lawfully required a prescription.

It is my understanding that, as a condition of the FDA's approval, Barr Laboratoreis will be monitoring pharmacy enforcement of the age-restriction and will be working to ensure that pharmacists are educated about these requirements so that they do not find themselves in such a situation or find themselves being diciplined by the state board of pharmacy.

4. You critique my use of "government-issued" to describe the ID that would be required for someone to purchase Plan B. I am not trying to be overly dramatic. I am merely trying to be informative and use the language the FDA used to explain to Barr Laboratories how the age-restriction would be monitored. That way, folks who read this blog would know what is expected of them if they were ever to purchase Plan B or explain to someone else how to purchase Plan B. It is my understanding that it wouldn't even have to be a photo ID--just a "government issued" ID, whatever that means and however dramatic you interpret it to be. For instance, people couldn't use a work or school-issued ID because it is not issued by the government. While you may be well-aware of what forms of legal ID there are, there are probably a large proportion of people who don't know and might try to use another form of ID. I'd also like to add that the FDA did not specify that it the ID would have to be a U.S. government ID.

5. I'd like to challenge your statement at the end of your response. You write that EC (or Plan B) is "a choice for both men and women in a world where we are all rapidly having our choices taken away from us." I completely agree with you but struggle to see how you meant that in terms of everyone, particularly after you discuss healthcare for low-income folks. You say, in so many words, that people of low-income should not risk getting pregnant because they cannot afford to take care of a child or cannot afford the means to prevent a pregnancy (i.e. EC). Well, the only 100% effective means to not get pregnant is to not have sex. Would you say that people of low-income, let's say a married couple, should not have sex because there's the chance that they might get pregnant?

You say, "poor people have plenty of options if they choose them" but it seems to me that the only option you're presenting is that they abstain from having sex altogether. Reproductive choice means nothing if you don't have the ability to exercise that choice. Medicaid is part of an extremely bureaucratic welfare system that some have learned to manipulate. But, staying on topic, Medicaid in Pennsylvania does not cover EC unless in cases of rape or incest. While you digress about how well poor people are treated in this country (and I staunchly disagree), you miss the point that right now EC is not covered by Medicaid unless in cases of rape or incest (neither is abortion--I'll open up another can of worms when i say that the ACLU and I also do not support this state action, as it prevents some women from exercising reproductive freedom). That means, that this is not an option for poor women, regardless of how great you think healthcare provided to them is.

More important than "honest perspective" is an ability to be patient and really hear what people are saying, where they're coming from, and create a friendly, open dialogue about sometimes controversial issues (between teens, parents, pharmacists,you, me). I thank you for sharing your point of view and am glad to have an opportunity to respond.

11:45 AM  
Anonymous The Bidge said...

I know there was a prior post about EC and Plan B here, which I recall responding to, and at that time I read all of the documentation that was linked from this site to elsewhere. And I do (now) recall the scientific methodology behind some of the restrictions, which may indeed be only politically-charged blather and unscientific and anything else but truth. So I will concede that point because I'm unqualified as a either a medical doctor or a scientist and can only rely on what I read for information. I also admit that it is not a purely legal decision. I do stand by my assertion that it is an excellent provision for preventing litigation.

I also never said that poor people should abstain from having sex. I wrote that poor people are equally capable of judgment and rationality, which includes but is not limited to using condoms (which can be obtained for free in nearly every sexual health clinic in America, not to metion in most hospitals and health care facilities), and other preventative contraception. Having grown up extremely poor, having been nearly destitute in adult life (no job and only 10 dollars to my name), having been homeless twice, I think I can safely speak for at least a few poor people out there on this matter. While poor, I had sex. While poor, I used condoms. It was and remains the sensible, repsonsible if-not-100%-effective thing to do. I minimized my risk of bringing a child into the world that I could ill-afford to take care of. Which is what I meant.

MOre on The Poor: Oh, there are more choices available today for poor people than there ever was. This is a good thing; I'm not complaining. I am unsure what the median income for poverty level is in today's America. When I was growing up in the 70's, it hovered at about $8000.00 I think...? Give or take a few thousand. (I'm too lazy to look it up), and our family income was approximately 50% of that for many long years. We survived because we had family who helped us when they could, which wasn't too often, but usually in the nick of time. We didn't have a phone or a TV or a radio. We didn't own a car. We did not have health insurance or dental and there were no programs for us. I did have a free library card, which I made excellent use of, and where I spent a lot of my time after school because we couldn't afford a babysitter while my mother worked two different waitressing jobs. Sometimes we went a few weeks without electricity. One winter (and this was before the laws that prevented it) we went without gas heat for a month--we did not have a fireplace. Then, you couldn't draw on your Social Security for assistance until retirement or a providing family member's death. There were no "deadbeat dad" programs. A single mother fended for herself. There was almost no programs besides welfare, and that was extremely limited compared to today's welfare system.

So, I may be fairly qualified to speak out on what choices poor people have now compared to what poor people had 30 years ago. The one thing that remains the same from my day is the food-stamp programs. It was the only program we could get on, and only because my mother (a single parent, mind you) had two children that she could ill-afford. And to this day, though she loves her children, she regrets more than anything that she had children too young and could not take care of us as well as she wanted to. There were no free abortion clinics anywhere nearby, which I suppose is lucky for me, because she would have if she could have.

How does this compare to the reality of today's poor? Have we not substantially progressed since then? I know we have.

Don't get me wrong, however, there are those who have it far worse today than my family did, who are living in squalid conditions unfit for any living creature, and are suffering not only from poverty but of racial prejudice and bigotry in crime-infested regions. By those standards, my childhood was heavenly. I do not fail to take that into consideration in my diatribes. Nevertheless, the poor are much better treated now and have much better programs available, in today's America, than they ever were. Shall I continue by comparing my wonderful childhood to today, or have I adequately made my point?

And I'm a lucky guy, you know. Right now, I'm sitting in a cozy flat in London (not in the best neighborhood, but far from the worst), at a computer, typing my opinion freely. I don't have loads of money, far from it but I've got a job, a wife, and we haven't gone hungry yet, and hey... we're not having kids because A) we couldn't afford them, and B) just because we can have kids doesn't mean we should (or even need to.) We don't abstain from sex, but we're repsonsible adults, capable of making rational decisions on how best to avoid an unwanted pregnancy. There's a "surgery" (local health clinic) within twenty-minutes walking distance that we frequent. We don't own a car, by the way, we walk--can't afford a car. But I'm still lucky nevertheless. I've got my wife who loves me and we look after each other, as family should.

So, maybe I am unqualified to speak for all families with children. But if we do ever have kids, there's no way in hell we would allow any doctor to subscribe anything to our minor children without our knowledge and consent first, except for when such medication is imminently necessary to save the lives of our children. I doubt that EC falls under that category.

To the points you made that I failed to address, I apologize. I have read them, and I am adding them to my worldview. I'm simply out of time. As always, I thank you for your comments.

2:08 PM  
Anonymous paula j said...

Bidge:
Let me assure you that here in the good 'ole US of A any teenager can walk into a free clinic and go on the pill, the patch, get condoms, VD treatment or even prenatal care and no one will ever call ma or pa.
Being known to my daughters friends as the "cool" mom (aka the one who actually speaks to them about sex) you can be sure few teenage girls would dicuss birthcontrol, abortion, sex, pregnacy, oral sex, anal sex, VD...etc. w/ their mothers or fathers. Too many parents would prefer to think their little wee 17 year olds are virgins and wouldn't be capable of handling the thought of them defiling themselves in some dark backseat. Few of the teens I ever met would bother asking their parents anything.
My advice to them was always this:
1) The main reason to stay a virgin is because most guys their age don't even know sex is a supposed to be pleasurable fun for both parties.
2) IF your going to have sex, go on birth control. Too many oopsies happen in the heat of the moment, when few folks will stop for a CVS pahrmacy condom run.
3) Be prepared to pay the price for a "mistake." Nothing is foolproof and realize that before you jump. It happens.
4) Here's where you can go for free exams, birth control, a pregnacy test, and to a few who already oopsed, for prenatal care.
I have had this conversation on many occasion, so it is obvious their are way too many parents yelling "there's no way in hell we would allow any doctor to prescribe anything to you without my knowledge and consent first!"
If you had kids, I hope they'd be smart enough to seek out preventative methods on their own.

11:21 PM  
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