Works In Progress - June 2006 - Who gets to decide what form of birth control a woman uses?

Who should be involved in deciding what form of birth control a woman uses? She should, certainly. Her partner? He has a role to play; he should be able to voice an opinion. Her doctor? A health care provider might share information as to what would be appropriate. Her pharmacist? Maybe, if there's a drug interaction of which she should be aware. God? Sure, if you're into that sort of thing. The owner of her local grocery store? I don't think so.

The owner of Ralph's Thriftway has taken the birth control choice of the women whom Ralph's pharmacy serves into his own hands by refusing to stock Plan B emergency contraception, commonly known as "the morning after pill." It should be noted that Plan B is not the same as RU486, mifepristone, sometimes called "the abortion pill." RU486 causes an implanted embryo to abort. Plan B is a contraceptive taken after unprotected sex or condom or other birth control failure. It will not affect an existing pregnancy, but instead disrupts the processes of ovulation, fertilization and implantation, much in the same manner as simple birth control pills. It is a contraceptive, not an abortifacient.

Is refusing to stock a drug that prevents unwanted pregnancies legal? In Massachusetts earlier this year, Walmart was sued by three women who were denied prescribed emergency contraception because the colossal corporation refused to stock it. Walmart changed its national policy regarding Plan B after the Massachusetts Board of Pharmacy investigated and found Walmart to be in violation of a state law that requires all pharmacies to stock commonly prescribed drugs. According to Jeff Smith of the Washington Board of Pharmacy, "we have the same rule here in Washington." Washington Administrative Code 246.869.150 states that a "pharmacy must maintain at all times a representative assortment of drugs in order to the meet the pharmaceutical needs of its patients." Granted, a pharmacy in a nursing home may not need to stock Plan B, but until recently I was a frequent customer at Ralph's, including the pharmacy there, and I can imagine a scenario in which Plan B might meet my pharmaceutical needs.

I believe that Ralph's is in violation of WAC 246.869.150. The Board of Pharmacy has a complaint process, but no complaints against Ralph's have yet been filed.

Currently, the Board of Pharmacy is considering the issue of "conscientious refusal," whether an individual pharmacist has the legal right to refuse to fill a prescription he or she finds morally objectionable. But individual pharmacists at Ralph's don't have to grapple with such a question, since Ralph's does not even stock, and has never stocked, emergency contraception. If the Board of Pharmacy decides against a pharmacist's right to refusal, could a store policy of not stocking EC be a way to nevertheless deny a woman access to contraception? Steve Saxe, Executive Director of the Board of Pharmacy in Washington says "the board is wrestling with this whole issue right now."

In Olympia, Plan B is available at Rite Aid, Albertson's, Kmart, Shopko, Target, Top Foods, Walgreen's and Walmart with a doctor's prescription. At Fred Meyer, Martin's Southgate Drug, and Safeway, Plan B is available without a prescription. Since 1998, emergency contraception has been available without a prescription in certain pharmacies if a pharmacist present has been certified to initiate therapy under signed protocols with a prescriber. This means that if a condom breaks on Friday night, a woman could walk into Fred Meyer on Saturday morning, talk to a pharmacist, and get emergency contraception immediately, without having consulted a doctor. After all, Plan B is so safe, an FDA advisory panel recommended it for over the counter status, only to be politically derailed by pro-life extremists.

Why is it that most of the pharmacies in Olympia don't participate in this program which allows EC to be dispensed without a prescription? One pharmacy tech complained that it was "too time consuming." Another pharmacist agreed, saying that the intake procedure "requires 20-30 minutes counseling time uninterrupted in a confidential place." Not surprisingly, the pharmacies that sell Plan B to women who walk in without a prescription seem to sell a lot more of the product than pharmacies that can't. At a pharmacy that participates in the protocol, a pharmacist who wished to remain anonymous estimated that they dispense Plan B "about once a day." At K-mart, however, which doesn't participate in the protocol, pharmacist Lon Lloyd says, "in the last 5 years we haven't filled a single prescription for Plan B."

So does it make sense from a business point of view for those pharmacies that don't sell much Plan B to keep it in stock? Jennifer Allen of Planned Parenthood points out that "it's good business to look out for the best interests of your customers, and that means timely access to medication." Emergency contraception is particularly time-sensitive, as it is most effective when taken as soon as possible after unprotected sex. Could a pharmacy like Ralph's lose money if it stocks Plan B, which has a shelf life of four years, but doesn't sell it? Not likely. Carol Cox of Barr Pharmaceuticals, the manufacturer of Plan B, states that "the company accepts returns of Plan B unopened, outdated packages." While it is possible that there isn't an enormous demand for Plan B at Ralph's, Ralph's has nothing to lose by stocking it. If Ralph's pharmacy dispenses enough Plan B to prevent one or two unwanted pregnancies a year, wouldn't it have been worth it?

Every pharmacy should stock emergency contraception. It is a commonly prescribed drug, classified by the World Health Organization as "an essential drug." The clock is ticking when a woman needs EC, and she may be particularly stressed and perhaps embarrassed if she has trouble obtaining it. She shouldn't have to waste time locating an unfamiliar pharmacy. She needs to get EC quickly to avoid an unwanted pregnancy; the Alan Guttmacher Institute estimates that as many as 51,000 abortions were prevented by EC use in 2000. Isn't reducing the need for abortions a goal we can all share?

I feel a sense of personal betrayal over this issue because I have spent so much money at Ralph's and Bayview. Once I got past the inspirational book section, I used to feel good about shopping at these stores. They are locally owned, and they make contributions to OFS (as well as other community organizations) when I make purchases there. Although I buy most of my groceries at the Co-op, there are some things the Co-op doesn't carry that I've just got to have. Where should I go instead? I don't like shopping at huge chains like Safeway or Albertson's. Top Foods is smaller (17 stores, all in Washington), but it's a long drive, and gas is expensive. My hope is that Ralph's will change its policy and start stocking Plan B, either as a result of legal challenge, or public pressure. A meeting has been scheduled for Monday, June 19th, time and location to be announced, to discuss possible actions community members might take regarding this issue. If you would like more information about this meeting, please send email or phone contact info to planboly@hotmail.com.

Pullquote options:

If the Board of Pharmacy decides against a pharmacist's right to refusal, could a store policy of not stocking EC be a way to nevertheless deny a woman access to contraception?

I feel a sense of personal betrayal over this issue because I have spent so much money at Ralph's and Bayview.