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The Honolulu Advertiser
Posted on: Monday, December 25, 2006

Some still awaiting Plan B pill

By Christie Wilson
Advertiser Neighbor Island Editor

PLAN B AT A GLANCE

1. What is Plan B?

Plan B is emergency contraception that can reduce the chance of pregnancy after unprotected sex. It should not be used as a regular birth control method because it does not work as well as most other forms of birth control that are used consistently and correctly.

2. How does it work?

Plan B contains a high dose of the hormone levonorgestrel, which has been used in birth control pills for more than 35 years. It prevents pregnancy by stopping the release of an egg from the ovary. It is possible that Plan B also may work by preventing fertilization of an egg or by preventing attachment to the uterus. It will not cause an abortion or affect an existing pregnancy.

3. Where can I get it?

1. Plan B is available from physicians, family-planning providers and community clinics. Anyone age 18 and older can purchase it from a pharmacy by showing a government-issued photo ID. Teens ages 14-17 can buy it without parental consent after undergoing a brief consultation with a pharmacist. Females under 14 can obtain it with parental consent or from a physician.

4. What are the directions for using Plan B?

Take the first tablet as soon as possible but not later than 72 hours (three days) after unprotected sex. Take the second tablet 12 hours after you take the first tablet.

5. How effective is Plan B?

It works best when taken within the first 24 hours after sex, but if taken within three days after sex, it will significantly decrease the chance of pregnancy.

6. Are there side effects?

Plan B has no serious or lasting side effects. Some women experience nausea, stomach pain, headache, dizziness, or breast tenderness, which are similar to the side effects of regular birth control pills.

7. What else do I need to know?

Plan B does not protect against the AIDS virus (HIV) or other sexually transmitted diseases.

Source: Barr Pharmaceuticals Inc.

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The U.S. Food and Drug Administration approved the Plan B emergency contraceptive for over-the-counter sales four months ago, but delays in repackaging and shipping the drug have meant that some Hawai'i pharmacies are still unable to offer it.

Planned Parenthood in Honolulu received its first shipment just last week and is selling Plan B for $30 for a single two-pill package. A dozen patients asked for the nonprescription emergency contraceptive in the first three days it was available, according to the organization's executive director Barry Raff.

An Advertiser spot check of 10 pharmacies showed that three were waiting for Plan B shipments, and at the seven that had it in stock, prices ranged from $35 to $60.

Barr Pharmaceuticals Inc., which manufactures Plan B, began shipping the nonprescription version of its emergency contraceptive Nov. 1, and spokeswoman Maren Smagala said it should be widely available in pharmacies across the country by early next year.

Plan B, commonly known as the "morning-after pill," is one form of emergency contraception (EC). It contains a hormone found in birth control pills and can prevent pregnancy by stopping ovulation or fertilization. It will not cause an abortion or affect an existing pregnancy.

Although the FDA approved over-the-counter sales of Plan B to adults, the drug is kept behind the counter. Anyone 18 and older can get the nonprescription pills by simply showing government-issued photo identification, as long as a pharmacist is on duty.

Hawai'i passed an "EC access" law in 2003 and is one of nine states that made Plan B available to adults and teens without a prescription prior to the FDA approval, although consultation with a pharmacist was required before the pills could be dispensed. As of October, 168 pharmacists representing 64 pharmacies had undergone training to sell Plan B, according to the state Board of Pharmacy.

While the FDA decision made it easier for adults to buy the pills, teens ages 14 to 17 must still undergo a brief consultation with the pharmacist, which lasts about 15 minutes and can cost upwards of $25 in addition to the price of the medication. Girls under 14 can get Plan B with parental consent or a doctor's prescription.

Figures on EC sales at pharmacies are not available, but the state Department of Health reported that during the 2005-06 fiscal year, its 39 contracted family-planning providers dispensed emergency contraceptives in 4,003 patient visits accounting for 14 percent of all patient visits. Planned Parenthood said it filled 2,700 requests for EC during that same period.

Nancy Partika of the Healthy Mothers Healthy Babies Coalition of Hawai'i, which pushed for the EC access law, said there is still some confusion about Plan B access among consumers and even some pharmacists.

Although guidelines for selling the nonprescription drug allow it to be sold to any adult, male or female, who presents identification, two pharmacies told The Advertiser it would sell the medication only to females, as a way to ensure the pills are being sold to the intended user.

"They should not be setting their own rules. There are guidelines and they do not specify sex, only that an ID be presented and that there be a pharmacist on site," Partika said.

Pharmacists are under no obligation to screen customers seeking Plan B, beyond asking for identification to confirm their age, she said. There are no restrictions that would prevent an adult from buying the pills for a younger relative or friend, and there are no rules against buying the product in advance to have on hand for future use.

Over-the-counter access also may be an issue for some Neighbor Island residents. Although emergency contraceptives are available from physicians, Planned Parenthood branches and other clinics, only 11 pharmacies on Maui, 10 on the Big Island and two on Kaua'i have pharmacists certified to provide Plan B consultations, according to the Board of Pharmacy. None were listed for either Moloka'i or Lana'i.

No matter who is buying the emergency contraceptive, Partika and Raff both say it should not be used in place of regular birth control.

"We see emergency contraceptives as a backup form of birth control," Partika said. "It is not intended to be the primary form of birth control and is not as effective and as inexpensive over time. It's important for women to see a healthcare or family-planning provider for ongoing birth control and ob/gyn care."

Over-the-counter medications are not covered by prescription drug plans, so women who can't afford to pay the retail price for Plan B will have to go the consultation route in order to get emergency contraceptives covered by health insurance.

Reach Christie Wilson at cwilson@honoluluadvertiser.com.