If you thought the Obama administration and Kathleen Sebelius were the only ones thwarting access to the Plan B emergency contraception pill, you would be wrong. A new study finds that many pharmacies are dispensing bad info to 17-year-old teenage girls, who are legally allowed to obtain the drug, which is available to them without a prescription but kept behind pharmacy counters.
To wit, pharmacies are telling these youngsters who call with questions that it is impossible for them to obtain the pill under any circumstances. In fact, a small percentage of pharmacies are saying similar things to physicians who call on behalf of their patients. "There still appears to be substantial access barriers for adolescents, largely based on misinformation," the study authors conclude.
The study, which was published in Pediatrics this week, had women call 943 pharmacies and pose as 17-year-old teenage girls or physicians calling on behalf of their 17-year-old patients. What happened? Well, 80 percent of the pharmacies told the adolescents and 81 percent told the docs that the morning after pill was available that day. But then it got interesting...
Nearly one in five pharmacies, or 145 of the total, told the adolescent callers that it would be impossible for them to get the pill. By contrast, 23 pharmacies, or 3 percent, told physician callers the same thing. Often, pharmacies conveyed incorrect age info for accessibility - 57 percent of the girls and 61 percent of the doctors, respectively, were given the right information about age limits.
[UPDATE: "I was really surprised that 19 percent of the adolescent callers were being told that, despite emergency contraception being available that day, they couldn't obtain EC simply based on on their age," Tracey Wilkinson, a professor in the Department of Pediatrics at the Boston University School of Medicine, and the lead author, wrote us.]
Meanwhile, the adolescents were put on hold twice as often as the doctors - 54 percent versus 26 percent - and spoke to people who identified themselves as pharmacists less frequently - 3 percent versus 12 percent. When the pill was not available, 36 percent and 33 percent of pharmacies called by adolescents and physicians, respectively, offered no additional suggestions on how to obtain it (here is the study).
[UPDATE: "I think overall this indicates that the current dispensing rules around EC do not guarantee access for adolescents, which is a problem because EC is a safe and effective form of pregnancy prevention that should be available to anyone who needs it, remembering that the sooner it is taken-the better it works," Wilkinson writes.]
What motivated the misinformation? That much is not clear, because the researchers did not incorporate motivation in their study. Although one could speculate that callers are more likely to get incorrect information about medications when speaking with someone other than a pharmacist on the phone. Clearly, the 'teen' callers were treated differently than the 'physicians.'
[UPDATE: "I have no doubt that when we called and identifies ourselves as physicians, we were talking to more senior people in the pharmacy and that could account for part of the difference," Wilkinson writes us. "But I also think that when the physician was calling, the pharmacy staff worked harder to get the correct answers to the questions. So, when an adolescent called, the first person that picked up the phone, no matter what their level of training, answered the questions and left it at that. Interestingly, in the calls that we did know we were talking to a pharmacist, it didn't predict that the right answers were given or not...which was also surprising to me."]
Of course, some pharmacies may have deliberately dispensed bad info, given ongoing controversy. Last month, a federal judge ruled the state of Washington may not force pharmacies to sell the pill or other emergency contraceptives, because the purpose of a controversial law was to suppress religious objections by pharmacists, not to promote access to those who may want or need the pill (read here).
Also last month, a coalition of reproductive rights advocates asked a federal judge to reopen a 2005 lawsuit challenging FDA access restrictions. The suit was effectively ended by an HHS decision late last year to overrule the FDA, which was going to permit teenagers younger than 17 from being able to obtain the pill without a prescription (see this).
10 Comments
is there any recourse in that situation? assuming the pharmacy is ignorant of the law and not just lying about it? how would one enforce one's right by law to a drug if the pharmacy was wrong and refused to sell it? call the cops? the FDA?
good questions, as usual, harpy. Not a lawyer, as you know. But, depending on what the governing law (which I assume is on state level), one would probably have to sue pharmacy if, as a result of their not selling, an unwanted pregnancy resulted.
Not a happy "solution", but I don't see another unless there was clear evidence of some form of illegal discrimination. Perhaps even then, suing pharmacy might be only option.
Issue would probably end up in Supreme Ct. around some sort of individual conscience case. Given current court (not to mix news stories), it would probably die there.
If the pharmacy chooses to carry a product they they assume the liability for providing correct information on how to obtain and use the product. But since when should a pharmacy have to carry a product? I don't agree with the confusing messages, it would be much easier to say "We don't carry that".
MC--I may be missing it, but I don't see anything in Ed's story about the pharmacies not carrying it.
I assume what you're saying is that a pharmacy only says "we don't carry that" when, in fact, they don't.
In the states of WA, OR and AZ (ones that I have a license in) your best recourse would be to file a complaint with the respective boards of pharmacy. The BOPs will then investigate the complaint, and take corrective action, if indicated. It is helpful in that regard to note the date, time and name of the person you spoke to, as well as note as close as you can the verbatim information that was given out.
On a separate note, I am silently weeping for my profession after reading this story.
A pharmacy is licensed by the state, and as such should meet basic standards including the carrying of a minimal group of pharmaceuticals as typically ordered by physicians whether they be Rx or OTC. Unwillingness to do same should result in fines and/or revocation of said license.
This is no different than regulations on businesses that carry out state licensed occupations. At this point barber shops in my state are more strictly regulated than pharmacies with the exception of controlled substances.
A physician is licensed by the state, should they be required to perform all procedures and tests whether they believe in them or not?
A pharmacy is still a private enterprise and as such should be able to choose what they carry and don't carry. By not carrying a product they accept the loss of sales for that product.
I would have liked to see the 145 pharmacies who stated they could not receive the drug broken down by chain or independent pharmacies. Most chains stores would frown on not ordering the drug for a patient.
All I see is another black-market outlet being geared up to get into business...bunch of pharmacists saying "no" won't change the needs of people for the therapy.
Too bad the pharmacists never questioned their conscience about all that oxycontin flying out the door...
When the government takes over all pharmacies they can mandate what is and isn't carried. Truthfully I'm looking forward to this. I'll have government holidays and never have to work more than a 40 hour week (if that!). I can join a union and use access to critical medicines as a bargaining chip. Everything will be better then.
By the way, pharmacists are obligated to report any diversion or attempted diversion of controlled substances. Docs running pill mills and writing OxyContin scripts for strained backs have largely created that problem.