Cost, Inequality, and Misinformation: Why Generic Emergency Contraception Is Still Inaccessible for Many

Though the FDA decision to permit generic EC pill manufacturers to sell their products over the counter represents a gain for those with the most access to resources, ultimately the decision reflects pharmaceutical manufacturing companies’ interests, rather than the lives of those most adversely affected by lack of access to EC.

There are still barriers to EC access, especially for women and teens of color who disproportionately live in poor and segregated neighborhoods. Contraception via Shutterstock

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Recently, the U.S. Food and Drug Administration (FDA) permitted generic emergency contraceptive pill manufacturers to sell their products over the counter. This is seemingly great news for increasing the variety of emergency contraceptives accessible to people who need them and making them relatively affordable, but there are still barriers to access specifically for women and teens of color who disproportionately live in poor and segregated neighborhoods that are routinely vulnerable to reproductive rights and justice violations.

After years of litigation, in 2013 drug manufacturer Teva was granted a three-year exclusivity agreement that would allow its product, Plan B One-Step, to be the only emergency contraceptive (EC) sold over the counter without age restrictions. However, that changed in February when the FDA sent a letter to generic emergency contraceptive pill manufacturers that permitted them to sell their products over the counter because Plan B’s exclusivity agreement was deemed “too broad.”

To compensate for reversing its prior agreement with Teva, the FDA requires manufacturers of generics, such as My Way and Next Choice One Dose, to have a label that says “for ages 17 and up,” though people will not be required to show proof of age. Plan B will be the only emergency contraceptive pill without a “17 and up” label.

Though the FDA decision represents a gain for those with the most access to resources, ultimately the decision largely reflects pharmaceutical manufacturing companies’ interests, rather than the lives of those most adversely affected by lack of access to EC. For example, following the FDA’s letter, Teva announced it would release its own generic called Take Action. It can do this because Teva still has exclusivity on the clinical trials that removed the age requirement from the label of its drug, and a U.S. appeals court ruled that drug companies can create and sell cheaper FDA-approved versions of their branded products, or generics, in 2005.

Despite not having to show proof of age to purchase, the age-restriction labels on My Way and Next Choice One Dose are confusing and misleading. A study released in December 2013, in which female researchers posing as 17-year-olds called more than 940 pharmacies, found that some 20 percent of pharmacy staff told callers that teens could not access emergency contraceptives at all. “That’s completely incorrect,” said the study’s lead author, Tracy Wilkinson. Of the remaining 80 percent of respondents, only about half of them got the exact age requirements for Plan B correct.

To test whether pharmacists were still spreading misinformation almost a year after Plan B was approved to sell over the counter without an age requirement, I called my own local pharmacy, which is less than a half of a mile from my apartment in Asheville, North Carolina. Unfortunately, the pharmacist told me it was sold behind the pharmacy counter, that I needed to show proof that I was 18 years old, and that my boyfriend could not purchase it for me—she said I had to come to the pharmacy and buy it myself. All of these assertions are false. In fact, Plan B is available in the “feminine hygiene” aisle at that particular pharmacy, without an age requirement—not to mention no gender requirement. My small “study” is not nearly as systematic as the one mentioned above, but it is an example of how pharmacists can spread misinformation that limits access to emergency contraception.

EC pills remain broadly misunderstood in terms of who has the right to access them. This misinformation can be devastating for poor women, especially poor women of color living in racially segregated neighborhoods. Women in these neighborhoods are much more likely to have limited pharmacy options and lack the means to travel to access necessary reproductive health care. For them, one phone call to what may be the only pharmacy to which they have access may represent their only real option for acquiring EC. Being rebuffed by a misinformed staffer when it is already difficult to reach a pharmacy may deter them from going to the pharmacy to check the accuracy of the pharmacist’s report. If pharmacists, people who are literally paid to know these rules, are unsure of the specifics, it is unreasonable to assume that many women will know enough to challenge or question them. Some women may even assume that those incorrect rules apply universally and avoid further investigation altogether, all because the constant rule-shifting and general vagueness of the regulations complicate the learning process.

Though the age label is nothing more than a bureaucratic necessity, it can be used as a deterrent. The label is not based on science or safety concerns for women and girls; it is strictly for the benefit of Teva’s bottom line as part of its exclusivity agreement with the FDA. As attorney Andrea Costello told the Guardian in 2013, “The administration is basically saying only those women who can afford to pay the monopoly price that Teva is going to demand have access to the morning-after pill.”

The lack of an age requirement label on Teva’s Plan B, Plan B One-Step, and eventually its generic Take Action give the company a virtual monopoly on the under-17 market—if, of course, teenagers can even afford the expensive drugs.

EC generics are only about 10 to 15 percent cheaper than Plan B One-Step, whose price averages $48. At their cheapest, the generics My Way and Next Choice One Dose will cost about $41. And Teva’s Take Action, the only generic on shelves without an age restriction, will cost $40. EC pills are cheap to manufacture; the price seems to be driven largely by corporate financial interest. Similar levonorgestrel-based emergency contraceptive pills average €15 (about $20) in Europe. The FDA’s approval of emergency contraceptive generics may encourage other manufacturers to enter the market and drive down costs, but it is still unclear whether prices in the United States will ever be as low as those in Europe.

In the meantime, women and girls are not offered consistent financial assistance for emergency contraceptives, which means the financial burdens will fall disproportionately on low-income women and teens of color who cannot afford to pay out of pocket for the drugs (that’s if they can even reach a pharmacy). The Affordable Care Act does not require insurance companies to cover non-prescription emergency contraceptives, and state Medicaid programs have varying policies surrounding emergency contraceptive coverage. Only eight states cover non-prescription EC on Medicaid. The majority of state Medicaid policies require a prescription, but Medicaid in states like Florida, Texas, South Carolina, and Mississippi do not cover emergency contraceptives under any circumstances. This means that women who are not fortunate enough to have insurance that will pay for non-prescription emergency contraceptives must pay for it themselves, which can be difficult, especially for low-income teenagers, who may see a $40 price tag for a contraceptive as an insurmountable obstacle.

Emergency contraceptives may not accommodate all bodies, but the availability of generics is supposed to increase access for people who need them. Low-income women and teens of color need them. Unfortunately, maintaining profit margins again proves to be more important than the best interests of women and girls as they are left incapable of exercising their human rights to make healthy decisions about their reproductive lives.