After years of complicated regulatory changes, including various age restrictions, levonorgestrel EC (Plan B One-Step, Aftera, and other generics) is available in the pharmacy without a prescription, aka over-the-counter or OTC, with no restrictions. However, the other form of EC pills available in the United States—ulipristal acetate (ella)—which is more effective than levonorgestrel at delaying ovulation, is currently only available by prescription (although it’s OTC in Europe!).
So, anyone can stroll into the pharmacy and pick EC up without a hassle?
Not so fast. Although the FDA has approved levonorgestrel EC for sale without a prescription or ID checks to anyone of any age, the on-the-ground reality is not so simple for many people who need EC. Several studies have found that pharmacies still ask for ID, refuse to sell it to men, or keep it stocked behind the pharmacy counter instead of on OTC shelves. The American Society for Emergency Contraception (ASEC) found in its last EC Access Survey that only 18% of stores stocked EC directly on the shelf with no locked security case, and 30% of stores told customers that ID is required to buy EC. ella, which is more effective at preventing ovulation, can be even harder to get. In addition to only being available by prescription, there are some other major barriers to getting ella. Many health care providers haven’t heard of it and don’t know to prescribe it. A 2016 study showed that only 29% of health care providers had heard of ella and 7% provide it. And even if a provider knows about ella and will prescribe it, pharmacies may not have it in stock. A 2018 study in 10 major cities in the US found that less than 10% of pharmacies had ella in stock and could dispense it right away.
Why do these barriers matter to EC access?
EC pills, especially levonorgestrel EC, are more likely to work the sooner you take them because they delay ovulation. So delays and barriers to getting EC, like asking for ID or not having it in stock when someone needs it, mean people might not get the EC they need in time.
Also, if someone weighs more than 165 pounds, levonorgestrel EC may not be as effective, so ella or a copper IUD would be more effective options for them, but both come with additional barriers, like needing a prescription for ella or a provider visit to get an IUD. And if someone weighs more than 195 pounds, ella may also be less effective as EC, so a copper IUD is their most effective option for EC.
What are some work arounds?
For anyone looking to stock up on EC for future use, there are some trusted online sources for getting EC at a lower cost—the only downside is that most don’t offer overnight shipping so it’s not a great option if you need it right away. As of 2019, Walmart sells My Choice EC online for $14.50, including shipping and both AfterPill and PRJKT RUBY sell levonorgestrel EC for around $20. You can also order ella from PRJKT RUBY, after a quick online consultation with a provider, for $67 including overnight shipping. Even better—in some places, you can get EC from a vending machine! Several college campuses have EC vending machines installed to ensure 24/7 access at a lower cost than the pharmacy. If you are or know a college student activist looking to do a concrete project on campus to help improve sexual and reproductive health, consider advocating for a vending machine. Contact ASEC—they can help!
How can you be an EC warrior?
- Educate yourself, your friends, other providers, and pharmacists. Make sure ella and the copper IUD, the most effective EC for people of any weight, are available when people need them. This might mean changing how people make appointments for an IUD or get a prescription for ella when they need it for EC.
- Let everyone know that levonorgestrel EC is available, OTC without prescription, ID check, age, or gender restrictions for anyone who needs it!
- Every time you go to a pharmacy yourself, check the EC section (usually next to condoms and other family planning supplies, sometimes in the feminine hygiene aisle). If EC is not on the shelf, have a chat with the pharmacy staff. Ask them why they don’t stock EC on the shelf. Make sure they know that there’s no age or gender restriction, so there’s no need to check ID. Print out this pharmacy guide from ASEC with all the up-to-date regulatory info and bring it to the pharmacy.
- Print out this EC 101 handout and give it away at events.
- Email ASEC if you or someone you know is denied EC.
The bottom line:
EC pills may not be the most effective way to prevent pregnancy, but they are an incredibly important option after sex has already occurred. When you need EC, time is of the essence—the sooner you take it, the more likely it is to work. Now more than ever, with reproductive rights under fire from all sides, we need YOU to help break down barriers that prevent people from getting EC when they need it!