Editor’s note: This blog post was originally published to Evidence Base on June 24, 2022.
The recent Supreme Court ruling striking down Roe v. Wade will likely result in 26 states implementing laws that restrict or ban access to abortion services. In many of these states, the legislation is so sweeping, it will also impact emergency contraceptives like Plan-B—also known as the “morning after” pill– and possibly prescription birth control.
As a result, states with laws protecting abortion and contraceptive access like California can expect an increase in demand as individuals cross state lines to obtain this care. One estimate from the Guttmacher Institute predicts people seeking abortion services or contraceptives in California will increase by 3000%– from 46,000 to 1.4 million people annually. Data from Google trends showed national interest for “buy Plan B online” jumped 160% following the leaked draft ruling from the Supreme Court.
States dedicated to ensuring women receive the care they need should fix existing gaps in contraceptive access.
Even in states without contraceptive restrictions, there are barriers to accessing Plan-B
The California legislature has proposed 13 bills to protect abortion rights since the draft opinion was leaked, but equitable access to contraceptives is not addressed.
In California, pharmacists are required to fill valid birth control or Plan B prescriptions regardless of religious or moral objections. Pharmacists may offer pharmacist-prescribed birth control, but they are not mandated to do so. The state also does not require pharmacies to carry or dispense Plan-B over the counter, meaning if the pharmacist has a concern or an objection, they do not have to provide emergency contraceptives to customers without a prescription.
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Research we published in Health Affairs in 2020 shows this results in disparities in access. We found that only one-in-ten pharmacies in Los Angeles County provided pharmacist-prescribed contraception and even fewer pharmacies provided this service for women and girls living in predominantly Black or Latinx and low-income neighborhoods, including those with high unintended pregnancy rates.
Even if all pharmacies implement pharmacist-prescribed contraception, many adolescent girls and undocumented immigrant women may still encounter barriers accessing it — we found that nearly three-fourths of pharmacies impose identification and age restrictions not required by law.
Three-quarters of LA County pharmacies sold over-the-counter emergency contraception, but nearly half also imposed age restrictions, despite the FDA removing such restrictions in 2013.
As a result, women in California—both residents and travelers, and especially adolescents—may be denied access to birth control and Plan B depending on where they go.
Additionally, while the Affordable Care Act requires insurance providers to cover contraception, these protections do not apply to the uninsured who may be burdened by the $40-$50 per pill price for Plan B.
Policy solutions needed
In states like California, the need for every pharmacy to carry Plan B pills is essential.
While well intentioned, dispensing mandates only help women who secure prescriptions. Most women traveling from a state with restrictive access to drugs like Plan B will likely not be able to get a prescription.
All pharmacies in California and other states that are protective of abortion and contraceptive access should be required to carry contraceptives – including Plan-B – and be mandated to dispense and sell to anyone who requests, regardless of age, with or without a prescription.
A similar dispensing mandate could also ensure that pharmacies access Title X funding to cover contraceptive costs for women who are low-income or uninsured regardless of age and without identification or documentation requirements.
Since the uninsured account for nearly one-third of US women needing publicly funded contraception, including pharmacies as recipients of Title X funding might increase access to birth control at no cost for the uninsured. Women are likely already traveling to states like California to purchase contraception. They should not face the additional burden of barriers at the pharmacy counter.
