Answers to Frequently Asked Questions About...
Emergency Contraception Over the Counter
Q&A About OTC Access to Emergency Contraception (EC)
In the U.S., Plan B One-Step is available without age restrictions to women and men (check the family planning aisle). One-pill generics (My Way and Next Choice One Dose) will soon be available on the shelf for consumers aged 17 and older, but this change has not taken effect yet; women 16 and younger still need a prescription. Two-pill generics (Levonorgestrel Tablets) are still available only behind the counter without prescription if you are 17 or older; younger women need a prescription.
Where can emergency contraception be sold at the pharmacy?
There are different regulations about how to purchase the different brands of EC available, so it can be quite confusing for consumers.
Plan B One-Step is sold on the shelf (most likely in the family planning aisle) with no restrictions. That means anyone can buy it without having to show ID. Plan B One-Step generally costs about $40-50.
- Soon, the generic one-pill products (Next Choice One Dose and My Way) will be available on the shelf next to Plan B One-Step, but you need to be 17 to buy them. Be prepared to show ID to buy these products. These generics generally cost about $35-45.
- The generic two-pill products Levonorgestrel Tablets are still available only at the pharmacy counter. Women and men aged 17 or older can buy them without a prescription. If you are 16 or younger, you need a prescription.
- ella is sold by prescription only, regardless of age. You can also order ella through an online prescription service for $59, including shipping.
Is emergency contraception covered under the Affordable Care Act (healthcare reform)?
The new health care law requires insurance companies to cover the full range of FDA-approved contraceptive methods and to cover them without imposing extra charges, like co-pays. This provision went into effect for new health plans starting on August 1, 2012 (or when the new plan year begins) so insurance companies are just starting to make these changes, and it is still unclear how EC will be covered. Your plan may not cover every brand of EC, or over-the-counter products. The best way to find out if EC is covered by your plan is to call your insurance company. The National Women’s Law Center provides a very helpful guide to what questions to ask your insurance company to understand your contraceptive coverage. Ask which brands of EC might be covered, and find out if your plan requires a prescription for insurance coverage. If your plan does not cover over-the-counter EC, you may want to get a prescription so that you will have coverage, even though progestin-only EC (like Plan B One-Step or Next Choice) is available without prescription if you are 17 or older.
Can purchasers of EC OTC still Medicaid reimbursement?
Because Medicaid policies differ in each individual state, there won’t be one answer to this question. Right now, Medicaid covers no OTC product in approximately one third of states; some OTC products in one third of states, and several OTC products in the other third. However, many states with Medicaid coverage for OTC products require prescriptions for the OTC products.
Can pharmacies provide EC to women under 17 years old?
Yes - one brand of EC (Plan B One-Step) is available without prescription to anyone, regardless of age. Soon, the generic one-pill products (Next Choice One-Dose and My Way) will also be available on the shelf, but only to those aged 17 or older. The generic two-pill product Levonorgestrel Tablets is still held behind the pharmacy counter, and is limited to women and men 17 and older. ella is available by prescription only, regardless of age. However, pharmacists can fill a prescription for women of any age and, in most states where pharmacists have prescriptive authority, there is no age restriction for dispensing EC. Collaborative practice agreements may not apply to ella.
Can pharmacies sell EC to a man? An older sister of a 16 year-old? A woman who is buying it “just in case”?
Yes. The FDA does not specify that the product must be sold to the intended user.
What are acceptable forms of proof of age for purchase of EC products that are restricted to those 17 or older (the generic products Next Choice One Dose, My Way and Levonorgestrel Tablets)?
Any government-issued identification is sufficient for proof of age. Examples of government-issued identification include but are not limited to:
- United States passport (unexpired or expired)
- Alien Registration Receipt Card or Permanent Resident Card, Form I-551
- An unexpired foreign passport that contains a temporary I-551 stamp
- An unexpired Employment Authorization Document issued by the Immigration and Naturalization Service which contains a photograph, Form I-766; Form I-688, Form I-688A, or Form I-688B
- In the case of a nonimmigrant alien authorized to work for a specific employer incident to status, an unexpired foreign passport with an Arrival-Departure Record, Form I-94, bearing the same name as the passport and containing an endorsement of the alien's nonimmigrant status, so long as the period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the Form I-94
- A driver's license or identification card containing a photograph, issued by a state or an outlying possession of the United States. If the driver's license or identification card does not contain a photograph, identifying information shall be included such as: name, date of birth, sex, height, color of eyes, and address
- School identification card with a photograph and date of birth
- Voter registration card
- U.S. military card or draft record
- Identification card issued by Federal, State, or local government agencies or entities. If the identification card does not contain a photograph, identifying information shall be included such as: name, date of birth, sex, height, color of eyes, and address
- Military dependent's identification card
- Native American tribal documents
- United States Coast Guard Merchant Mariner Card
- Driver's license issued by a Canadian government authority
How do the FDA requirements for providing progestin-only EC differ from the more stringent requirements for pseudoephedrine products?
The only requirements for pharmacies providing EC over the counter are that the purchaser is 17 or older and can show proof of age and that the product is kept behind the counter. Unlike the requirements for pseudoephedrine products, there is no requirement that pharmacies keep a log of purchaser names, addresses, or amounts purchased.
How much product can I sell and how much can a customer buy?
There is no limit to the number of doses of progestin-only EC (Plan B One-Step, Next Choice One Dose, Next Choice or Levonorgestrel Tablets) that can be bought or sold over the counter. The only product that can be sold by prescription is the two-pill generic product Levonorgestrel Tablets. If it is sold by prescription, a dose limit may be indicated by the prescriber.
Are Plan B One-Step, Next Choice One Dose, Next Choice and Levonorgestrel Tablets available OTC in clinics?
Yes. Assuming they have a system in place for confirming age, health care clinics can distribute EC over the counter (OTC) to women and men 17 and older. In addition, they can continue to dispense EC to anyone who needs a prescription.
Is ella available OTC?
No - ella (ulipristal acetate) is sold by prescription only.