Good News? Yes. A Historic Breakthrough? Not Quite.

Posted on 6.13.2013 by Lily

So a lot's been going on with Plan B lately, yeah? Let's recap the events of the last few months:

In April, Judge Edward Korman raked the Obama administration over the coals for playing politics with emergency contraception and ordered them to grant the 2001 (yes, really) Citizen's Petition to make Plan B over-the-counter with no age or point-of-sale restrictions whatsoever.

In May, the Obama administration appealed his order because why not drag this endless saga on for as long as humanly possible? Why not maximize the number of days in which women's lives are changed forever because they can't access EC? Meanwhile, the FDA was off making a sweetheart deal with Teva (the company that manufactures one brand of EC) to lower the OTC age to 15+, but give Teva's brand OTC market exclusivity. I explained a few weeks ago why this policy, despite the lowered age from 17 to 15, would actually make the situation more harmful to girls and women than the current 17+ behind-the-counter status.

Last week, the Obama administration was ordered to make the two-pill version of EC immediately available over-the-counter. A few days ago, they responded by announcing that they would drop their efforts to restrict sales of the one-pill version (also known as Plan B One-Step). The two-pill version, however, they still want restricted since young girls might be flummoxed over having to take so very many pills! I mean, two pills versus one, that's tricky - math is hard, amirite girls? Good thing we have the Justice Department protecting us from straining our pretty little brains over figuring out how on earth you take two pills that come together.*

Anyway, all the different policy proposals and rulings and orders are convoluted and confusing and pretty emblematic of this decade-plus long struggle to get emergency contraception, arguably the safest medication in existence and one of the most critical for women's health, to be sold simply like Tylenol and condoms so that everyone who needs it can just… go ahead and buy it.

Pro-choice advocates like Cecile Richards, president of Planned Parenthood Federation of America, and Nancy Northup, president of the Center for Reproductive Rights, are hailing these most recent events as "huge victories" and "historic moments" for women's health and rights. "Finally, after more than a decade of politically motivated delays, women will no longer have to endure intrusive, onerous, and medically unnecessary restrictions to get emergency contraception," said Northup after the Second Circuit Court of Appeals ordered the administration to make the two-pill version available OTC.

Really, Nancy Northup? Really, Cecile Richards?

I recognize these are good steps forward, but I see them as that: baby steps forward. And not baby steps over the finish line, either. I think maybe I can see the finish line from here, but it's still a ways off.

It's either overly optimistic, naïve, or politically calculated to say that women are no longer going to face unnecessary restrictions to getting emergency contraception. We don't know exactly what the details of the policy will look like; the Obama administration submitted their retraction of appeal to Judge Korman, who still has to approve it. (And he doesn't take any shit, so we'll see if what they proposed is good enough for him!) Then, perhaps most importantly, we'll see what happens with brand names versus generic EC and market exclusivity. Plan B can run pretty expensive – over $50 is not uncommon for a pack, and a generic can be about $35, which is still fairly pricey for a one-time medication. If Teva has market exclusivity on Plan B One-Step on store shelves, as I delved into previously, it was estimated that the pill would cost over $60. Obviously the difference between brands and generics matters. If Plan B is now available OTC without age or point-of-sale restrictions, but the only OTC option costs over $60, are we really better off? Are the women and girls who are most disadvantaged – the ones who stand to benefit the most from a policy change – really going to be better served when they can get the pill without a prescription and without having to show ID, but they have to cough up more than $60 to do so?

I can't celebrate this news yet. Not until I know exactly how it's going to be put into place: what's going to happen with generics, will Teva have market exclusivity, what will prices be, whether they'll ever stop this ridiculous game of distinguishing between the one-pill/two-pill versions as though they're not the same exact damn thing, will EC actually be more accessible and affordable to everyone who needs it. Time will tell. All I can say now is that while we're seeing some cautiously good news, it's just the next agonizing slow step in the right direction in our country's sordid history around this life-changing medication. It's really not a historic moment, so let's not get out the champagne just yet.

*I do admit that there is a disadvantage to the two-pill version in that the instructions still in many cases say to take the two pills twelve hours apart. This is unnecessary; taking the two pills together, as if they were one pill, is just as effective as taking them twelve hours apart, and much simpler. Women following the twelve-hour instruction are more likely to forget the second dose, which renders the regimen useless. But this is a problem of the packaging instructions, which should be changed to reflect the two-pills-together guideline; moreover, paternalism is not a good reason to keep the pills behind the counter – especially when there are generic two-pill versions that could be a lot cheaper than the one-pill OTC version.