Plan B: To Shelve, or Not to Shelve
Emergency contraception is on the hot seat again
As Andrew von Eschenbach settled into a chair in a U.S. Senate hearing room in Washington, D.C., last week, Kevin Stormans sat down in his office in the other Washington, the Evergreen State. Both men prepared for the same thing: tough questions about their refusal to allow the sale of Plan B, the emergency contraceptive pill for women.
Von Eschenbach, acting head of the Food and Drug Administration, was hoping to be confirmed for the job but got grilled by senators over why the agency has blocked the already-approved prescription drug from being sold over the counter. Stormans, co-owner of Ralph's Thriftway in Olympia, spent another day dealing with a boycott because he won't sell Plan B at all; he thinks it's like an abortion and morally wrong. "Stores ought to be able to make a choice on what they sell or don't sell," says Stormans.
For women and for Plan B, all this means that what happens in the nation's capital may be trumped by local actions. Pharmacists in Illinois, New Hampshire, and other places have, like Stormans, refused to dispense the drug. Some governors have ordered pharmacists to do so, others have upheld their right not to, and state pharmacy boards are now crafting regulations to allow some wiggle room. And at the end of the day, von Eschenbach was still not official FDA head because senators such as Democrat Patty Murray of Washington said "he left things more confused than when he came in" and refused to allow a confirmation vote.
Plan B has been Topic A in health circles since an FDA advisory panel approved over-the-counter sale in 2003. But the agency, in a rare move, overruled the panel, prompting charges it caved to pressure from groups who equate the pill with abortion. (Plan B prevents an egg from being fertilized or keeps a fertilized egg from the uterus.)
Delay. The day before the hearing, von Eschenbach said he would move to approve over-the-counter sales if the manufacturer would restrict sales to women 18 and older and sell only at pharmacies so women could "get guidance" from a pharmacist. But his inquisitors pointed out the FDA had found no evidence of a need for the age limit. And since von Eschenbach refused to give them a timetable for approval, they charged this was another delaying tactic.
Stormans may see less delay from his state's pharmacy board, which will vote this month on a regulation "that would allow a pharmacist to not dispense it for moral reasons," says Steven Saxe, the board's outgoing director. "But it does require them to make sure the patient gets the drug someplace else in a timely manner." That may not be a problem in Olympia, with other nearby pharmacies stocking it. But in rural areas, denial could result in a mad dash to find the pill--there's only a 72-hour window for it to work.
This story appears in the August 14, 2006 print edition of U.S. News & World Report.