Isle teens could lose access to 'morning after' pill

Hawaii teens under age 18 would not be able to get "morning after" contraception pills without prescriptions if a proposed federal policy goes into effect and supersedes state law, said Nancy Partika, executive director of the Healthy Mothers, Healthy Babies Coalition.

She said the Food and Drug Administration's guidelines might be less restrictive but would apply only to women 18 and older, while Hawaii's emergency contraception law covers teens age 14 and up.

"We already have better access in Hawaii than the FDA is proposing," Partika said. "Our goal is for all women of childbearing age to have optimal access to EC (emergency contraception)."

She said the FDA is proposing "behind the counter" access that would limit which pharmacies could distribute the pills, along with "some fairly heavy-handed monitoring and enforcement mechanisms," she said.

"So we would potentially roll backwards if ... the FDA moved forward with it."

Her coalition worked with the Pharmacists Association and other organizations to get the 2003 state law allowing nonprescription access to emergency contraception, and it is working well, she said.

Emergency contraception pills are birth control pills in stronger doses. They do not interfere with an established pregnancy, but are intended to prevent an unplanned pregnancy. They must be used within 72 to 120 hours after unprotected sex or a failed contraception method.

In Hawaii, pharmacists who undergo special training and have collaborative agreements with physicians are able to dispense emergency contraception without prescription to women and teens age 14 and up. An intake process includes answering a questionnaire and consultation with the pharmacist.

Partika said 169 isle pharmacists are offering emergency contraception. Hawaii's law is a model for other states, she said. Eight others now have such access: Washington, California, New Mexico, Alaska, Maine, New Hampshire, Massachusetts and Vermont.

Barr Pharmaceuticals Inc., which makes the emergency contraception pill sold as Plan B, has sought permission for over-the-counter sales for three years, changing the age restriction several times to address FDA concerns.

The company said it would raise the age to 18 for nonprescription sales of Plan B, but it could not be accountable for pharmacies that did not follow the restrictions.

The emergency contraception issue has been embroiled in religious and political controversy nationally.

Democratic Sens. Patty Murray of Washington and Hillary Rodham Clinton of New York have said they will block acting FDA Commissioner Andrew von Eschenbach's confirmation as permanent FDA head until the agency announces whether it will approve or reject Plan B nonprescription sales.

Planned Parenthood supports continued nonprescription access to emergency contraception for all females age 14 and up, said Veronica Ryan, director of patient services.

She said the FDA proposal would improve access for women age 18 and older, "but high-risk teens would have to jump through more hoops, even though they're more at risk."

Cost is one of the barriers to access for teens, who might not have cash or insurance, Ryan said.

Pharmacists surveyed in June were charging an average of $50.86 for both the medication and counseling, according to Healthy Mothers, Healthy Babies. The average counseling fee is $25, but 31 percent of pharmacists surveyed are not charging for it. The average medication cost is $34, the coalition said.

Planned Parenthood, one of 38 federally funded family planning clinics, prescribes* offers the emergency contraception pills for a fee based on a sliding scale, Ryan said. Most teens get them for free, she added.

Hawaii's program has been "pretty positive," said Cindy Minakami, clinical pharmacist for Longs Drug in Hawaii.

She said more than 35 Longs pharmacists had received training and had issued more than 1,000 emergency contraception pills since they began participating in 2004. Training is continuing for other Longs pharmacists, she said.

They have had clients as young as 14, she said. "Even though doctors have the same guidelines that we do, they (teens) feel they can trust pharmacists more."

The teens and women are all referred to doctors for follow-up, Minakami said. Many are receptive because they have no obstetrician or doctor, she said. If they are referred to a doctor and they do not go, she said, "We call them. We have information on the screening questionnaire."

Access to emergency contraception appears to be improving, but the survey shows significant barriers still exist statewide, reports Healthy Mothers, Healthy Babies. More education is needed, especially targeting teens and women ages 14 to 35, it said.