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'Morning-After' Pill Gets Legal Boost

Calif. HMOs must pay for emergency prescription by pharmacists

MONDAY, April 1, 2002 (HealthDayNews) -- While many jurisdictions inch toward requiring greater access to the little-known "morning-after" pill, three states have stepped in the forefront of efforts to make the contraception more available in a hurry.

Last week, California Gov. Gray Davis ordered HMOs to pay for all emergency contraception prescriptions even if a pharmacist writes them instead of a doctor. In California, Washington and Alaska, pharmacists are allowed to prescribe the pills, which prevent pregnancy after risky intercourse.

Few women know that the pills are available. A 2000 study by the Kaiser Family Foundation found that only a third of women surveyed knew they could buy them in the U.S.

Emergency contraception has been the "best-kept secret in reproductive health," said Jane Hutchings, senior program officer at the Seattle-based Program for Appropriate Technology in Health (PATH). "Patients didn't know to ask for it."

At first, doctors told women to take large doses of normal birth control pills after risky intercourse, and that is still an option. In 1998, the Food and Drug Administration approved the use of two drugs -- Preven and Plan B --that offer the same effects in much smaller doses.

The pills can prevent or delay ovulation, said Hutchings, whose organization helped make emergency contraception available in Washington state.

It's not clear what happens if an egg is already fertilized by sperm. The pills may prevent the fertilized egg from implanting itself into the lining of the uterus, she said.

"How they work for any particular person would depend on what point in the cycle a woman took them," Hutchings said.

Women take emergency contraception pills in two doses. The first must be taken within 72 hours after intercourse; the second should come 12 hours later.

The pills are most effective when the first dose is taken within 24 hours of risky intercourse. As a result, activist groups have been pushing for laws that allow pharmacies to offer quick and easy access to the drugs.

As of Jan. 1, California became the third state to allow pharmacists to prescribe emergency contraception pills themselves so long as they follow guidelines established by a doctor. Washington state and Alaska have similar systems.

An estimated 1,000 women in Washington receive prescriptions from pharmacists each month, Hutchings said. About 250 pharmacists offer the service.

Across the country, access to emergency contraception is "great in some places and abysmal in some places," said Meg DeRonghe, assistant director for governmental relations with Planned Parenthood, which offers the drugs in its clinics. "The very nature of emergency contraception is that it's needed at times and hours that aren't existing clinical business hours. The spottiness [of access] is pretty dramatic."

About 10 states are "seriously" considering laws that give pharmacists the right to prescribe emergency contraception, said DeRonghe.

Washington state also requires hospitals to provide emergency contraception to all victims of sexual assault, DeRonghe said. Illinois has a similar law, but it only mandates that hospitals give information to the victims, she said.

Critics consider emergency contraception a form of abortion, and a survey by Catholics for a Free Choice, a pro-choice Catholic organization, found that 82 percent of 589 Catholic hospitals surveyed refused to provide it to sexual assault victims.

According to DeRonghe, about 18 states require HMOs to pay for contraceptives under prescription benefits. While she welcomes Davis's decision ordering HMOS to pay for emergency contraception regardless of whether a doctor or pharmacist prescribes it, she said Planned Parenthood feels that all of those states should do the same under their laws.

The next step, Hutchings said, is for politicians to make emergency contraception available without a prescription. "Over-the-counter access would be the biggest boon to reducing barriers," she said.

What To Do

While the morning-after pills may prevent you from getting pregnant after risky sex, they won't prevent sexually transmitted diseases.

Learn about emergency contraception, including where you can get it, from www.not-2-late.com, operated by the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals.

Another resource is emergencybirthcontrol.com.

SOURCES: Jane Hutchings, senior program officer in reproductive health, Program for Appropriate Technology in Health, Seattle; Meg DeRonghe, assistant director for governmental relations, Planned Parenthood, Washington D.C.
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