Experience shows that family-oriented supermarkets can function as family-planning centers, too. Yet some pharmacy directors are already conceiving of ways to avoid controversy that may result from the over-the-counter switch of the morning-after pill, a move the Food and Drug Administration is contemplating.
Sources interviewed for this story believe strongly in their right to sell family-planning products, including Plan B, the morning-after pill supplied by Barr Pharmaceuticals, Woodcliff Lake, N.J. However, when selling items that by their very nature allude to sexual behavior, retailers want to avoid alienating any part of their customer base.
"As pharmacists, we're involved in helping people select products for family planning. We find they're more comfortable asking for and picking items. Years ago, we'd see people sneak them. Now it's not uncommon for women or men to bring items to the counter, even if there's a group of people around," noted a pharmacy director for a Midwestern chain.
"Especially with the need to protect against HIV, it's more acceptable for people to purchase these products," the pharmacy director said. "They've not gone the way of covering magazines at retail." SN agreed not to name the retail sources in this story so they could speak freely about potentially controversial positions.
Indeed, supermarkets (excluding supercenters) control $55.0 million of male contraceptive sales, up 1.0% during the 52 weeks ended Dec. 27, 2003, out of a total food-drug-mass market (excluding Wal-Mart) of $262.6 million, up 0.8%, according to ACNielsen Strategic Planner statistics. Supermarkets' share of female contraceptives is far less, just $6.4 million over the same period, down 9.0%, vs. total food-drug-mass sales of $58.9 million, down 5.2%.
Despite such mainstreaming, retailers seem wary of the country's conservative mood since Wal-Mart obscures Cosmopolitan on its shelves, Clear Channel pulled radio personality Howard Stern from its stations, and the public voiced a strong response to singer Janet Jackson's breast flash at the Super Bowl.
"I don't think it will make a hoot's worth of difference in how people behave if the morning-after pill goes on sale over-the-counter," said another supermarket chain pharmacy director. "I do think if it went on open display, we'd probably get some public backlash. That the pill would make teens promiscuous is a bunch of crap, but we'd only need one person out of 1,000 to make a problem for our stores.
"However, right now we feel we wouldn't have it on open display, not only because of any potential social risk of merchandising it. There are too many chances for side effects. It shouldn't be something anyone could buy randomly as an OTC. This isn't like the turkey wars, where we shout, 'We won't be undersold."'
He concurred with others who feel FDA won't make a final decision until after the presidential election in November because the topic is too hot. An FDA advisory panel had voted 23 to 4 last December to recommend that Plan B be made available without a prescription. FDA is currently expected to rule on May 21. Barr Pharmaceuticals Chairman and Chief Executive Bruce Downey told securities analysts in March that "the dissenters weren't concerned about product safety or if people could self-administer, but whether without age restriction it could increase promiscuity and unprotected sexual activity."
A recent editorial in the New England Journal of Medicine "suggests that FDA's decision-making process is being influenced by political considerations," said its authors, who included two members of the FDA advisory panel and NEJM editor Jeffrey Drazen, M.D. "The current delay ... may be followed by approval with restrictions on its over-the-counter sale that are designed to intimidate women who require access to this medication. ... If a woman does not have the medication on hand when needed, the delay entailed in obtaining a prescription -- and thus in initiating therapy -- can seriously reduce its efficacy."
Even with a prescription, pharmacists sometimes present roadblocks to consumers, according to media reports from around the country. For example:
Three Eckerd pharmacists in Texas were fired recently for refusing to dispense the morning-after pill to a rape victim.
A relief pharmacist at a Wisconsin Kmart refused to refill a birth-control prescription for a woman due to his religious beliefs.
A Missouri legislator has proposed a bill to protect the jobs of pharmacists who refuse to dispense morning-after contraception.
The American Pharmacists Association backed a CVS pharmacist in Texas who refused to fill a birth-control prescription, while also supporting pharmacies that establish alternative ways for patients to get their medications.
"We've generated a policy of our peers," explained a chain pharmacy chief. "If you're uncomfortable filling a particular product, make sure the person can get it filled in our store by a different pharmacist. If you still have a problem, then call me. You may not like it, but the consumer has a right to have it filled. We're in the health care business."
Another retail pharmacy source said, "We wouldn't say one way or another. No one is saying they have to fill, and we haven't threatened to fire anyone who won't. Just let a colleague behind your bench fill it." He said it's not a major issue for his chain because there has been little demand for the morning-after pill at his small-market stores. "I don't think 20% of our stores even have it. For us to sit on $40 of inventory is stupid. In our markets, if we don't have it, a store down the street will." He suggested that consumers would possibly go to a drug store first for such a product anyway.
Meanwhile, the University of Washington School of Pharmacy and the Department of Obstetrics and Gynecology have enrolled 50 women in a study that provides them with birth-control pills without a doctor's prescription. Women aged 18 to 45 first need to complete a questionnaire, have their weight and blood pressure taken, and consult with a pharmacist. Pharmacists at the eight participating pharmacies in Seattle received eight hours of special training and operate under a physician's rules. The researchers hope to be able to monitor the contraceptive behaviors of up to 300 women for a year.
Six years ago, Washington became the first state to allow pharmacists to give women a morning-after pill without a doctor's prescription. According to Barr Pharmaceuticals, a limited number of pharmacies in Alaska, California, Hawaii and New Mexico can also provide emergency contraception.
How Plan B Works
Plan B is the first progestin-only emergency contraceptive to be approved by the FDA. It cannot terminate an established pregnancy. A single course of treatment is two tablets, each 0.75mg levonorgestrel, that block implantation of a fertilized egg in the uterus, according to the www.go2planb.com Web site.
Taken within 72 hours of unprotected intercourse, Plan B has been shown to reduce the risk of pregnancy by 89% after a single act of unprotected sex. Effectiveness declines as the interval between intercourse and the start of treatment increases. Plan B is most effective when taken within the first 24 hours after intercourse.
The decline in efficacy from a delay in treatment is why a broad range of health professionals believe that barriers to more timely access to Plan B should be removed. Plan B does not protect against HIV/AIDS or sexually transmitted diseases.
Another emergency contraceptive approved by the FDA is Preven, from Gynetics, Belle Mead, N.J., which combines the hormones estrogen and progestin.