FDA Eases Limits on 'Morning-After' Pill

Women may buy the morning-after pill without a prescription — but only with proof they're 18 or older, federal health officials ruled Thursday, capping a contentious three-year effort to ease access
( [email protected] ) Aug 25, 2006 01:25 PM EDT

WASHINGTON (AP) - Women may buy the morning-after pill without a prescription — but only with proof they're 18 or older, federal health officials ruled Thursday, capping a contentious three-year effort to ease access to the emergency contraceptive.

Girls 17 and younger still will need a doctor's note to buy the pills, called Plan B, the Food and Drug Administration told manufacturer Barr Pharmaceuticals Inc.

The compromise decision is a partial victory for women's advocacy and medical groups that say eliminating sales restrictions could cut in half the nation's 3 million annual unplanned pregnancies. Opponents have argued that wider access could increase promiscuity.

The pills are a concentrated dose of the same drug found in many regular birth-control pills. They prevent ovulation or fertilization of an egg, and also may prevent a fertilized egg from implanting into the uterus, considered the medical definition of pregnancy. Pill opponents argue that would be tantamount to abortion.

When a woman takes the pills within 72 hours of unprotected sex, she can lower the risk of pregnancy by up to 89 percent. The earlier it's taken, the more effective Plan B is. But it can be hard to find a doctor to write a prescription in time, especially on weekends and holidays. Hence the push to allow nonprescription sales.

Barr has said it hopes to begin nonprescription sales of Plan B by the end of the year. The pills will be sold only from behind the counter at pharmacies — so the pharmacist can check photo identification — but not at convenience stores or gas stations.

There isn't enough scientific evidence that young teens can safely use Plan B without a doctor's supervision, Dr. Andrew von Eschenbach, the FDA's acting commissioner, said in a memo.

But Barr did prove that over-the-counter use is safe for older teens and adults — and licensed pharmacies are used to checking for proof of age 18 before selling tobacco and certain other products, von Eschenbach wrote in explaining the agency's age cutoff.

Plan B's maker was disappointed that FDA imposed the age restriction and pledged to continue working the agency to try to eliminate it.

"While we still feel that Plan B should be available to a broader age group without a prescription, we are pleased that the Agency has determined that Plan B is safe and effective for use by those 18 years of age and older as an over-the-counter product," said Bruce L. Downey, Barr's chairman.

The age restriction remains controversial even inside FDA, agency drugs chief Dr. Steven Galson told The Associated Press Thursday. Galson has acknowledged overruling his staff scientists' opinion in 2004 that nonprescription sales would be safe for all ages.

"Let me be frank, there still are disagreements," Galson said in an interview. "There were disagreements from the first second this application came in the house."

But, "I'm convinced adolescents are a different group, they require special analyses, sometimes special data," he added.

As a condition of approval, Barr agreed to track whether pharmacists are enforcing the age restriction, by, among other things, sending anonymous shoppers to buy Plan B. FDA said Barr is to conduct that formal tracking at least twice in the first year of sales and annually thereafter, and report stores that break the rules to their state pharmacy licensing boards.

But Barr also will conduct a national education campaign to raise awareness of emergency contraception, among both women and health providers.

The two-pill pack of Plan B costs from $25 to $40. A Barr spokeswoman estimated that pharmacists dispense about 1.5 million packs a year.

Nine states — Washington, California, New Mexico, Alaska, Hawaii, Maine, New Hampshire, Massachusetts and Vermont — already allow women of any age to buy Plan B without a doctor's prescription from certain pharmacies. Proponents of those pharmacy access programs believe that minors won't see any change in those states, because the pharmacist already technically writes a prescription.

The FDA approved prescription-only sales of Plan B in 1999, and the quest to sell nationwide without a doctor's note began in 2003. That year, the agency's independent scientific advisers overwhelmingly backed nonprescription sales for all ages, and FDA's staff scientists agreed.

But higher-ranking officials rejected that decision, citing concern about young teens' use of the pills without a doctor's oversight. Barr reapplied, asking that women 16 and older be allowed to buy Plan B without a prescription. Then, last August, the FDA postponed a final decision indefinitely, saying the agency needed to determine how to enforce those age restrictions.

Nationwide nonprescription sales were widely consider a doomed issue until last month, when the FDA reversed itself and said it would reconsider if Barr agreed to an age 18 restriction. That surprise announcement came on the eve of a Senate committee hearing on whether to confirm von Eschenbach as FDA's new head.

Thursday's decision is expected to remove a Senate roadblock to his full confirmation.

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