Recently, federal Judge Edward Korman accepted the Obama administration’s proposal to make Plan B One-Step — a one-dose form of emergency contraception — available over the counter without a prescription, an age limit or point-of-sale restrictions.
This decision means that Plan B One-Step will be available to everyone in all stores, not just pharmacies, for purchase without an ID or prescription.
While this ruling is an historic win for women generally, it may be a victory in name only for teens, women of color and low-income women because only the more expensive brand name drug will be immediately available.
The court’s order allows the FDA to grant market exclusivity to Teva, the maker of Plan B One-Step, which means that more affordable generic versions may remain behind the counter — available to adult women and older teens without proof of age and to younger teens with a prescription only.
As Judge Korman noted in his opinion: “Market exclusivity means that no other manufacturer will be permitted to market its products over-the-counter for three years … This confers a near monopoly that will only result in making a one-pill emergency contraceptive more expensive and thus less accessible to many poor women.”
Currently Plan B One-Step costs between $10 to $70 dollars without a prescription, which can be cost prohibitive, not just for teens but for many women working full-time, low-wage jobs.
For instance, women of color who work full time are more likely to work in minimum wage jobs, earning them roughly $14,000 a year. Many women are supporting entire families while living below the poverty level, which is currently $19,530 for a family of three. They have limited access to health care coverage and preventive services like birth control while also lacking the cash on hand necessary to purchase emergency contraception immediately after unprotected sex or a contraceptive failure.
Ultimately, the women who are at the highest risk of unintended pregnancy have the greatest inability to pay for brand name emergency contraception.
Depending on which state a woman lives in, Medicaid may cover emergency contraception with a prescription.
According to the Kaiser Family Foundation, only 25 states and the District of Columbia cover emergency contraception under their state family planning benefits package. And nine states have specifically excluded emergency contraception in some way, including the elimination of coverage from state contraception mandates and laws allowing pharmacies to deny filling requests or prescriptions for EC.
The saving grace for many women and teens without health insurance will be Obamacare, which will provide affordable health insurance options to millions of uninsured, low-income Americans next year and under which emergency contraception is already covered at no cost to women with a prescription.
While it is a great benefit to women with Medicaid or private insurance to not have to pay for the drug, scheduling a doctor’s appointment to get a prescription costs women something much more valuable — time. Emergency contraception is a high dose of the hormone found in traditional birth control pills that is most effective when taken within 72 hours of unprotected sex to prevent pregnancy. Thus, having to obtain a prescription in essence defeats the purpose of having an “emergency” method available on store shelves.
The court’s decision is a major victory for women’s health overall, but it still has a disparate impact. Having emergency contraception on store shelves is not equal access for all when the inability to pay renders it inaccessible for those who need it most.
Heidi Williamson is senior policy analyst at Center for American Progress.