Robin Laananen
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On Aug. 12, a little-known drug company called Women's Capital Corp. (WCC) will launch a 10-week local ad campaign for something called Plan B. If you've never heard of it, you're not alone, but for many women, this lack of awareness could be tragic. Plan B is a "morning-after" pill that, when taken within 72 hours of unprotected sex, can prevent unwanted pregnancy. Drugs like Plan B could help at least 1.5 million women—the number of women in America who get pregnant due to contraceptive failure—each year.
Though emergency contraception (EC) has been around in various forms for nearly 30 years (see "A Short History of Emergency Contraception"), the first efforts to promote it began only five years ago. Today, despite the growing list of EC remedies and publicity efforts, public awareness has remained appallingly low.
"What's unsettling about this is that these drugs can have a huge public health impact," says Jane Hutchings, senior program officer at Program for Appropriate Technology in Health (PATH), the Seattle organization that coordinated early efforts to bring EC to the state.
Paulette Walker-Row, director of pharmaceutical care at the Washington State Pharmacy Association (WSPA), says that not only do women not know about the drugs, but even if they do, they don't always know that the drugs are available in pharmacies and through clinics that keep longer hours than a doctor's office. Among the first 1,200 women to request the drugs in Washington state, she says, between 50 percent and 60 percent sought the drug after 6 p.m. on a weekday or over a weekend.
Gynetics, the Lawrenceville, N.J.- based company that sells an EC drug called Preven, estimates that more than 50,000 unintended pregnancies begin each week in the U.S. While women, even minors, have access to the drug in other countries such as England (where grocery and drug chain Tesco dispenses it for free), Denmark, Israel, South Africa, and Canada, it's much harder to find in the U.S.
So why isn't the drug better known or utilized? Surprisingly, anti-abortion foes aren't the main reason. The truth has more to do with the mechanics of the pharmaceutical industry and drug advertising.
Sharon Camp, CEO of WCC, is aware that launching a print and radio ad campaign in sleepy Seattle won't make Plan B a household name like Pfizer's Viagra, Eli Lilly's Prozac, or Schering-Plough's Claritin—at least not with her start-up company's fledgling marketing budget. Yet, if there is one state where Plan B, or any other emergency contraceptive, ought to take off, it's Washington. That's because the state's pharmacy, physician, insurance, and government agencies have all implemented policies to make EC access easy.
"One of the things that the ad campaign will test is whether we've saturated this market or we're picking the low-hanging fruit in terms of audience," Camp says. "The major barrier to increasing sales of Plan B is that women don't know they have the option." Right now, Washington state accounts for 14 percent of the Washington D.C.-based company's Plan B revenues.
Despite this state's pro-EC measures, Camp says that sales haven't picked up that much since the drug first became available three years ago. "Awareness is not growing," she says. Walker-Row says that state pharmacies prescribe EC a combined total of 1,200 times per month—a figure that has remained flat over the past few years.
Washington made its first strides with EC in 1997, when Seattle nonprofit PATH led a domestic pilot of an EC program it had created for family planning in developing countries. Leveraging a 1979 state law that lets pharmacists prescribe specific drug types (such as flu shots) directly to customers after securing a doctor's consent and approval through a "collaborative drug therapy agreement," PATH has turned pharmacist prescription of EC into standard practice—a first in the U.S. Following Washington's lead, California began offering residents pharmacist prescription in January, and states including Alaska, Ohio, Montana, and New York are evaluating doing so.
The number of pharmacies that offer EC through collaborative agreements in Washington has grown from 40 in 1998 to over 250, according to PATH's Hutchings. While that's progress, this represents only about 20 percent of the state's 1,242 pharmacies, as counted by the WSPA. "It's still vastly underused," says Hutchings. "I think the key thing is once it becomes institutionalized—taught at the university pharmacy schools and associations—it's going to become more routine." Pharmacy schools of the University of Washington and Washington State University have added discussion of the drugs to the curriculum, she says.
Washington was also one of the first states to require all state-regulated insurance plans to cover EC, through a ruling from the state insurance commissioner's office that became law in January. Forty percent of the Washington population is covered by state-regulated insurance, according to Robert Harkins, executive director of Planned Parenthood Affiliates of Washington. He adds that 50 percent of pregnancies in Washington state are unintended, though the number that are "unwanted" within that statistic is harder to quantify. But both Harkins and WSPA's Walker-Row point out that since 40 percent of all unwanted pregnancies result in live births, and half of those births are state-subsidized at $3,600 per birth, offering a $35 drug is clearly logical from an economic perspective.
