The state's second-largest health insurance company and some large pharmacy chains are reporting an increase in the purchase of Plan B, an emergency contraceptive that was approved for over-the-counter sales last year.

No agency appears to be tracking emergency contraception use statewide, but individual providers say evidence suggests that the purchase of Plan B is on the rise.

Officials say it's too early to determine what the impact is on unplanned pregnancies and abortions, but clinics say they've seen fewer women coming in for pregnancy tests.

"I think more women are using it. I think there's more awareness of it than ever before," said Dr. Ann Rahall, Planned Parenthood of Hawai'i's medical director.

A BACKUP MEASURE

Commonly known as the "morning-after pill," Plan B is a two-pill form of emergency contraception that contains a hormone which can prevent pregnancy by stopping ovulation or fertilization. While not intended to replace traditional — and more effective — forms of contraception, it provides a backup for women wanting to avoid an unintended pregnancy after unprotected sex.

"It reduces the need for abortion and reduces the number of mothers who aren't ready because they continued when they didn't want to be pregnant," Rahall said.

The Federal Drug Administration's approval of Plan B as an over-the-counter medication across the nation ended a three-year debate over whether the medication was safe for all women. The FDA rules require teens to receive consultation before purchasing the pills.

In Hawai'i, the rule change made it more readily accessible to women 18 and older. Since 2005, Hawai'i was one of eight states that did not require a doctor's prescription to get the pill, but the state mandated a consultation with a pharmacist before obtaining it.

The federal guideline approved last year lifted that condition for women 18 and older, but kept it in place for girls 14 to 17, who legally can obtain the pill from pharmacies.

During the FDA deliberations about the rule change, family planning advocates voiced concern that further removing barriers to obtaining the pill could encourage unprotected sex.

DEMAND TRIPLES

At Kaiser Permanente, one of the state's largest insurers, the demand for Plan B at regional clinics has tripled since 2004. Since the provider has its own pharmacies, it is able to track how often the pills are purchased.

"We noticed as soon as the over-the-counter became available that there was a large shift (from) the number of patients needing prescriptions to purchasing it on its own," said Barbara Kashiwabara, director of pharmaceutical services at Kaiser.

In 2004, Kaiser pharmacies filled about 30 prescriptions a month. When pharmacists in Hawai'i were given authority to dispense it without a doctor's prescription in 2005, the demand for it doubled.

Since the mandate was lifted for a consultation with the pharmacist, about 90 women a month have been buying it from the Kaiser clinics.

Now Kaiser is trying to track whether increased access has reduced unplanned pregnancies and abortions among its members. "Theoretically, that's how it should work," Kashiwabara said.

The Hawaii Medical Service Association, which insures more than half of the state's residents, said it has seen a reduction in claims for prescriptions since women started buying Plan B without a prescription. Last year, HMSA processed 1,500 prescription claims. As of last month, only 525 claims had been processed in 2007.

Meanwhile, individual pharmacists at Longs and Safeway said that they've been selling more Plan B since it went over the counter.

At the University of Hawai'i, the number of women seeking emergency contraception has remained stable at about five to 10 a day.

FEWER PREGNANCY TESTS

At the same time, Sue Myhre, nurse coordinator for UH's Women's Health Clinic, said "as a rule, we don't have to see as many people for pregnancy tests any more."

Myhre thinks price helps explain why university students may opt for the clinic, rather than the drugstore. Although women who visit the clinic are required to have counseling before they are allowed to purchase Plan B, the university compensates by offering significantly lower prices: $15, compared to $30 at Planned Parenthood and up to $60 at other pharmacies.

However, judging from a decrease in claims to HMSA and fewer emergency contraception appointments at Planned Parenthood, it appears that more women are paying more for the convenience of being able to buy the pills at the nearest drugstore.

"It's not an inexpensive alternative, but it is a lot less expensive than a pregnancy or abortion," said Kaiser's Kashiwabara.

Between Planned Parenthood and services provided through the state Department of Health's Family Planning Program, clients requesting prescriptions for emergency contraception dropped by more than 2,000 clients during the past fiscal year, which ended June 30.

Teenagers age 14 to 17, who are still required by law to consult with a pharmacist before purchasing emergency contraception, have kept sales at Planned Parenthood higher than expected, most likely because teens — who have to pay a consultation fee on top of the drug charge — are more sensitive to the higher expense of buying Plan B from a local pharmacy.

As at UH, Planned Parenthood has seen fewer positive pregnancy test results for women who used no contraception, or whose method failed.

The most recent report from the state Department of Health shows that in 2005, teenage pregnancies and abortion rates both were down.

From 1996 to 2005, pregnancies of girls under age 18 dropped by almost 400 a year, with 819 pregnancies reported in 2005.

During the same time period, abortions for women of all ages dropped from 4,871 to 3,534.

Reach Treena Shapiro at tshapiro@honoluluadvertiser.com.