Problems with Emergency Contraception (EC) at a Pharmacy? -- DAWN Emergency Contraception Project

DAWN Emergency Contraception Watch Project

Monitoring Women's Experiences accessing
Plan B - the Emergency Contraception Pill (ECP)

Action Alert

Women: Has a pharmacist REFUSED to sell you
Emergency Contraceptives now available
behind-the-counter?

If so, the DAWN Emergency Contraception Watch Project
would like to hear from you!

Please tell us about your experience.

The change from the ECP's status from prescription to
non-prescription has just replaced
one barrier (access) for another (cost).

Problems with Emergency Contraception (EC) at a Pharmacy?

Please use the form below to report any problems you have had obtaining Emergency Contraception (EC) at a pharmacy.

Then click [send] at the bottom of the form to submit information.

Thank you for your help.

(* A red asterisk means the field is required)

CONFIDENTIAL

* First Name:

* Last Name:

* Email Address:

Area Code & Telephone Number:

Patient's Name if Different: :

* Pharmacy Name and City:

If for Emergency Contraception, how long after the sexual encounter were you refused by the pharmacy?:

Date that service was refused:

Did you eventually find a pharmacy to serve you?:

Any other comments about your experience?

You may also email us directly at dawnontario@sympatico.ca

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Today Women have a second chance to
prevent an unintended pregnancy.

It's called Emergency Contraception - EC for short.
It's safe and effective, if taken in the first few days after sex.

But for EC to work, Women need to know about it
- and be able to get it in time.

So prepare yourself.

What is EC?

Simply put, emergency contraception – or EC for short – is a back-up method of birth control. Despite the many highly effective birth control options women have to choose from, none is 100% perfect. And sometimes, mistakes happen – a condom breaks, a diaphragm slips, a woman forgets to take her pill. Or she has sex when she didn’t plan to – or want to. Emergency contraception (EC) gives women a second chance to prevent pregnancy in the first few days after sex.

EC is a safe and effective way to help prevent pregnancy after unprotected intercourse or contraceptive failure. It is available in the U.S. today.
EC is a higher dosage of the same hormones found in daily birth control pills.
EC - when used within days of unprotected sex - can significantly reduce the risk of unintended pregnancy.

EC can be used to reduce the risk of pregnancy up to three days after unprotected sex. EC does not terminate established pregnancies, and should not be confused with the "abortion pill," which is not licensed for sale in Canada.

EC helps to prevent pregnancy, and doesn’t work if a woman is already pregnant.

Plan B Emergency Contraception Pill (ECP)

Effective April 19, 2005, upon direction from Health Canada, the Plan B emergency contraceptive pill (ECP) will be available without a prescription. (Previously, women have had to get a physician's prescription before they could get the drug.)

What is ECP?

An emergency contraceptive pill (ECP) is a hormonal pill that reduces the risk of pregnancy after contraceptive failure or unprotected intercourse. They are sometimes misleadingly called "morning-after pills." ECPs are effective, however, for up to 72 hours (three days) after unprotected intercourse. Timely access is important, because the sooner a woman takes ECP, the more effective it is (Plan B is 89% effective when taken within 24 hours of unprotected sex). ECPs are safe for any woman of reproductive age. Some research suggests that ECP may work up to 5 days after unprotected sex, but the pills are more effective if they are taken earlier.

Is ECP the same as the abortion pill?

No. ECP has absolutely no effect on an established pregnancy. If a woman is already pregnant, taking ECP will not cause an abortion. Abortion pills are not licensed for sale in Canada.

Before today, how could women get ECP?

Plan B was approved by Health Canada in 2000 for use as an ECP. Federal regulations specified that Plan B was a prescription drug under Schedule F of the Food and Drug Regulations of the Food and Drugs Act, although provincial
legislation determined who had the authority to prescribe it. In Ontario, women had to see a physician to get a prescription for ECP.

How can women get ECP now?

Plan B is now a non-prescription drug that will be available "behind the counter." This means that women have to consult with a pharmacist before they can get it. The pharmacist will do an assessment of the woman's need for the drug, provide information on how to take ECP, and provide further contraceptive counseling or a referral to another health-care provider if needed.

What Questions can Women expect during consultation with pharmacist?

The pharmacist will ask you the date of your last menstrual cycle prior to episode of unprotected sex. They will also discuss "contraindications" with you -- I had to push to get examples of such contraindication related questions and here is the two I was given by a local pharmacist: 1) whether you're already pregnant because you can't get it if you're already pregnant, and 2) if you've had more than one episode of unprotected sex since your last menstrual cycle).

The ECP (Levonorgestrel 0.75 mg) has been available in Canada with a prescription for the last 5 years! A first dose taken within 24 hours of unprotected intercourse, followed by a second 12 hours later, is 89% effective in preventing ovulation, fertilization and implantation; and highly effective if taken within 72 hours of unprotected intercourse.

There are no serious adverse effects to the woman or, if she happened to be already pregnant, to the fetus. As well, levonorgestrel satisfies all of the criteria for nonprescription status, including a long history of safe and effective use, low incidence of side effects (mainly mild nausea) and a simple and easily explained manner of use. Studies of self-administered oral emergency contraception have shown a high level of appropriate use without adverse effects.

[Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339(1):1-4. New England Journal of Medicine]

[Raymond EG, Chen PL, Dalebout SM. "Actual use" study of emergency contraceptive pills provided in a simulated over-the-counter manner. Obstet Gynecol 2003;102(1):17-23. Obstetrics & Gynecology 2003;102:17-23]

Why, then, must competent women who have experienced contraceptive failure, a lapse in caution, or sexual assault be regarded as fair game for an unnecessary level of intervention by a pharmacist — at their own expense?

According to Health Canada, pharmacists are "well-positioned to play a major role in ... providing counselling about contraceptive options" during these mandatory consultations.

[Government of Canada. Regulations amending the food and drug regulations (1272 — levonorgestrel). C Gaz2004; 138(21):1633-43. Available: www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/sch-1272_e.html (accessed 2005 Mar 3).]

It is bloody well insulting to women to presume that women need pharmacists "to make the woman aware that Plan B is not meant as a regular form of birth control, nor does it protect against STIs" as suggested by Garth McCutcheon, the President of (CPhA) Canadian Pharmacist Association!

Quoting Garth McCutcheon, President, CPhA

"... There are health issues (in addition to the risk of pregnancy) of which she may not be aware that should be addressed at the time EC is being considered, for example, sexually transmitted infections (STIs). We believe it is responsible health policy to ensure that a trained health professional raises these issues and offers to help women to address them. The pharmacist will assess if Plan B is indeed appropriate (based on the timing of unprotected sex and the risk of pregnancy). They will ensure the woman is made aware of Plan B, how it works and how to use it effectively. They will advise about how to best manage any side effects and when to expect her next period. They will make the woman aware that Plan B is not meant as a regular form of birth control, nor does it protect against STIs. They will refer the woman to other health care resources, if needed, and – very important – help relieve any anxiety or uncertainty about her decision to use Plan B." Source

Hopefully, Garth McCutcheon's attitude is not representative of the attitude women can expect in their local pharmacists.

While pharmacists do have front-line contact with patients and are equipped with professional guidelines for provision of emergency contraception, they are not ideally positioned for a counselling role in their typical practice settings. Depending on the pharmacy, there may or may not be a confidential area available where pharmacists can consult with women seeking ECP. (And be sure that pharmacists will have to pass along to the consumer, an appropriate fee for their consultation time - can you spell cost as a barrier to access?)

This has nothing to do with the degree of knowledge, skills, and professionalism possessed by a Licensed pharmacists to sensitively supply emergency contraception ...

This HAS everything to do with a significant cost barrier it creates for women - specifically low-income women.

This has to do with the Canadian Pharmacists Association posturing themselves to get a bigger slice from the pharmaceutical pie.

The fact that it will do so on the backs of women is just temporary as they lobby for healthcare dollars to redirect the counselling dollars previously billed by doctors.

What possible benefit will pharmacists' advise present to low income women when the provision of that advise now comes at a cost that precludes low income women's access access to emergency contraception ???

Quoting Mark F Kearney, community pharmacist

"... For this reason, many pharmacist associations have been lobbying the provincial and federal governments and many private insurance plans to continue paying for emergency contraception, and the consultation that accompanies it, when it switches to non-prescription status. In this manner, women will derive all of the benefits of the consultation without having cost as a barrier to access. Forward-thinking pharmacists will choose to charge a fee for the consultation because they understand that this fee can be claimed by a woman though income tax or through a private flex-benefit insurance plan whereas, currently, the cost of the medication cannot." Source

How much will ECP cost?

If obtained at a pharmacy, the cost of ECP will be the wholesale cost plus a mark-up decided by the pharmacy. This mark-up is unregulated. It is up to the pharmacy to decide what price is fair (cough - bull - cough). Plan B appears to be available in most Canadian pharmacies at a cost of approximately $25 to $50.

The price is sure to increase as the Canadian Pharmacists Association lobbies to get pharmacists paid for their counselling service. Quebec and Saskatchewan already pay pharmacists about $16 per EC consultation — the same rate as a family physician. By the way, it is not mandatory that pharmacists be trained to provide this counselling service; it is only strongly encouraged.

With the change from prescription to non-prescription status, ECP many no longer be covered by drug plans which creates a cost barrier to access.

Typical isn't it? A policy change comes down the pike lauded to improve timely access to emergency contraception - particularly for women sitting on waiting lists with no access to family doctor - and women find themselves facing a new barrier relating to cost - a cost that will have to increase to cover pharmacists' counselling services. Clearly women have j had one barrier reduced only to be replaced by another. And typically it will be low income women who will find themselves at the very bottom of the privilege ladder once again.

Women should note that they can also obtain the ECP from sexual health clinics & public health units. (best option between Monday to Friday).

The treatment consists of two small pills that each contain .75 mg of levonorgestrel, slightly more hormone than a daily birth control pill.

The World Health Organization (WHO)
includes EC on its list of essential medications.

It is available without a prescription — and in some cases without a pharmacist's intervention — in 28 countries,
including France, the UK, Denmark & Norway.

Experiences in other countries indicate that
easier access does not lead to excessive use.

Relevant Links

More About Plan B
http://www.go2planb.com/

Emergency contraception: Get the Facts!
Planned Parenthood Federation of Canada (PPFC)
http://www.ppfc.ca/ppfc/content.asp?articleid=274&cn=False

Emergency contraception moves behind the counter - Editorial
Can Med Assoc J 2005 172: 845-845
en français: La contraception d'urgence derriere le comptoir

Nonprescription status for emergency contraception - by Barbara Sibbald
Can Med Assoc J 2005 172: 861

Canadian Women's Health Network (CWHN)
http://www.cwhn.ca

Ontario Women's Health Council
www.womenshealthcouncil.on.ca

Back Up Your Birth Control
http://www.backupyourbirthcontrol.org/