Most effective oral emergency contraception not stocked in most Kansas City pharmacies

Few pharmacies in Kansas City, KS, stock ulipristal acetate (UPA [Ella—Afaxys]), the most effective form of oral emergency contraception, according to a recent study published in the Journal of the American Pharmacists Association.

In this secret shopper survey by French and colleagues, two female investigators posed as patients from June to July 2017 and contacted 165 pharmacies (84 chains, 61 store associated, and 20 independent) within 25 miles of the University of Kansas Medical Center. They asked the individual answering the phone—including pharmacy staff, technicians, and pharmacists—if UPA was in stock. If it was not, they asked why the medication wasn’t stocked, if it could be ordered, and how soon it would be available. They then asked the same questions for oral levonorgestrel, also known as Plan B (Teva Women’s Health).

The researchers found that only 7% of the 165 pharmacies involved in the study stocked UPA. By contrast, 78% carried oral levonorgestrel. Chain pharmacies (13%) were more likely to have UPA in stock than store-associated (1%) and independent (0%) pharmacies.

While few pharmacies had UPA immediately available, 62% reported that they could obtain it within 24 hours. However, chain pharmacies (70%) were more likely to be able to obtain UPA within 24 hours than store-associated (57%) and independent (45%) pharmacies. Of the pharmacies who did not stock UPA, 52% reported that it was due to few or no requests for the medication, and 10% reported that they had not heard of it.

UPA and oral levonorgestrel are the only single-pill emergency contraception regimens available in the United States. Oral levonorgestrel is available as an OTC and can be used up to 72 hours after intercourse. UPA, on the other hand, is available by prescription only but can be used up to 120 hours after intercourse. It has also proven to be more effective than oral levonorgestrel in women with obesity.

The study authors support making UPA available as an OTC to increase accessibility to the medication. UPA is already available in most European countries and Australia without a prescription. Collaboration between prescribers and pharmacy staff, as well as allowing pharmacists to prescribe UPA, could also increase patient access to the medication, the authors wrote. Currently, eight states allow pharmacists to directly prescribe UPA to their patients.

“Efforts are needed to improve prescriber knowledge, streamline prescribing practices, and increase patient awareness” about the efficacy of UPA, the authors wrote. This could increase the demand for the drug, and therefore increase the likelihood of pharmacies stocking it.