Washington, D.C.—While it remains unclear what the U.S. Supreme Court's reversal of the landmark Roe v. Wade decision will mean for pharmacies, several pharmacy chains and big box stores apparently expected an initial run on emergency contraceptives.

Without the right of a pregnant woman to choose to have an abortion in some jurisdictions, the use of emergency contraception is expected to increase.

According to media reports, CVS Health said it began limiting purchases of Plan B and Aftera, which cost $49.99 and $39.99, respectively, to three per order the day after the decision was officially released. Less than a week later, it lifted the restrictions.

News outlets also reported at least initial purchase restrictions from Rite Aid, Walmart, and even Amazon.com. Walgreens did not establish a purchase limit.

The Guttmacher Institute advised that four emergency contraception products have been approved by the FDA, with three of them approved for preventing pregnancy when taken within 72 hours after unprotected sex. The FDA approved one of those products, Plan B One-Step, for OTC sale in 2013.

What pharmacists can expect is the reigniting of the debate over when and how members of their profession and pharmacies can refuse to dispense emergency contraception.

"Since the late 1990s, state legislatures have taken different paths to expand access to emergency contraception," according to the Guttmacher Institute. It notes that some states have attempted to restrict access by excluding emergency contraception from state Medicaid family planning eligibility expansions or contraceptive coverage mandates, or by allowing pharmacists to refuse to dispense them..

The states that specifically allow pharmacists and/or pharmacists refusal to dispense emergency contraceptives include Arizona, Arkansas, Georgia, Idaho, Mississippi, and South Dakota, according to a Guttmacher state tracker. Several others have a broadly worded refusal policy that might apply to pharmacists or pharmacies but does not specifically include them.

A recent article in the journal Contraception expressed concern because 26 states are likely to severely restrict access to abortion following the Supreme Court decision in Dobbs v. Jackson Women's Health Organization.

The article noted that "access to emergency contraception will be more important than ever. Existing barriers to emergency contraception—including cost, obstacles to over-the-counter purchase, low awareness and availability of the most effective options, myths about safety and mechanism of action—already substantially limit access. Proactive solutions include public information campaigns; healthcare provider education about all emergency contraceptive options, including IUDs and advance provision of emergency contraceptive pills; innovative service delivery options such as vending machines and community distribution programs; and policy initiatives to ensure insurance coverage, eliminate pharmacy refusals, and support all service delivery options."

The article from emergency contraception advocacy groups, as well as pharmacy schools, urged the FDA to approve updated labeling "to align with the best available evidence that oral contraceptive pills work before ovulation and do not prevent implantation of a fertilized egg, as this language contributes to public confusion and access barriers."

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