Massachusetts' statewide standing order policy resulted in a significant increase in emergency contraception spending at pharmacies compared to other states, a recent study found. JAMAICA.¹

Emergency contraception is essential for preventing pregnancy after unprotected sex or contraceptive failure. It can be used several days after contraceptive failure and still prevents pregnancy by inhibiting ovulation.²

The first oral emergency contraceptive available in the United States was a tablet containing the progestin levonorgestrel. Progestin-based emergency contraceptives are most effective when taken within 72 hours of unprotected sex, reducing the risk of pregnancy by 81 to 90%.²

Ulipristal can also be used as emergency contraception and has been available in the US since 2010. It is a single-dose pill that can prevent pregnancy for up to 5 days after unprotected sex. There are no serious side effects associated with either progestin-based pills or ulipristal.

Many states have restricted access to abortion, increasing the need for emergency contraception. To address this problem, Massachusetts has implemented a statewide standing mandate for emergency contraception.¹

The standing order allows pharmacists to prescribe prescription ulipristal (Ella) and over-the-counter levonorgestrel (Plan B). While pharmacists in 27 states are allowed to prescribe oral contraceptives to their patients, they must complete additional training before gaining access to them.

Because Massachusetts policy removes barriers related to contraceptive prescriptions, a study was conducted to examine the association with emergency contraceptive dispensing in pharmacies. Participants included women ages 15 to 49.¹

Changes in emergency contraceptive refills from July 2021 to May 2022 were compared with those from August 2022 to December 2023, since the statewide order was issued in August 2022. All changes were evaluated using a quasi-experimental difference-in-differences design.

The primary outcome of the analysis was monthly emergency contraceptive use rates, while ulipristal and prescribed levonorgestrel were reported as secondary outcomes. Results were reported per 100,000 women.

The final analysis included 92,500 emergency contraceptive devices from July 2021 to October 2023. Prior to implementation of the standing order, Massachusetts saw a slight increase in emergency contraceptive devices compared to the comparison states, but overall trends were similar.¹

Before the permanent prescription, a rate of 78.5 uses of emergency contraception per 100,000 women was reported, after the permanent prescription, the rate was 105.3 uses per 100,000 women. This represents an increase of 26.8 uses per 100,000 women.

In the comparison states, the rate of emergency contraception use was 45.8 use per 100,000 women before the statewide standing prescription and 48.4 use per 100,000 women afterward. In the adjusted difference-in-differences analysis, this meant that Massachusetts required 25.2 additional use of emergency contraception per 100,000 women compared to the comparison states.¹

For ulipristal, there were 31.6 additional prescriptions per 100,000 women in Massachusetts compared to the comparison states. However, no significant differences were observed for levonorgestrel prescriptions, which were -6.4 prescriptions per 100,000 women.

These results showed a 32 percent increase in the number of emergency contraceptives dispensed in Massachusetts pharmacies compared to comparison states, as well as a switch from prescription levonorgestrel to ulipristal. The researchers concluded, “Policies that reduce barriers to prescribing can improve access to emergency contraception, particularly ulipristal.”¹

References

1. Qato DM, Guadamuz JS, Myerson R. Changes in emergency contraceptive refills under the Massachusetts statewide standing order. JAMA. 2024. doi:10.1001/jama.2024.11715
2. Emergency contraception. KFF. August 4, 2022. Retrieved June 3, 2024.