THE PULL OF THE PILL

MARJORIE SHAFFER

Supermarket pharmacies are in heavy price competition for women who use birth control pills. Pharmacists view these patients as important in building up a loyal customer base for their business as well as gaining incremental sales for the chain's food operation.

Women who use birth control pills must return to the store monthly to get their prescriptions refilled, and frequently they will buy other items once they are in the store, supermarket pharmacists say.

Moreover, when these women do have children, they are likely to use the same pharmacy to meet the health needs of their growing families.

"Everybody is trying to get these women into their store because their prescriptions for birth control pills have to get refilled every month," says Jay Buckley, pharmacy manager of a Giant Eagle supermarket in Bridgeville, Pa. "And because we are in a supermarket setting, these women pick up a lot of other items when they come in for their prescriptions." Other pharmacists agree, adding that women who are satisfied with their oral contraceptives frequently become loyal customers. "For the most part, the women getting birth control pills stay with you," says Kathleen Butts, a pharmacist at a Winn-Dixie store in Orange Park, Fla. "In the future, when their husband or kids get sick, they usually will come to the pharmacy where they got their oral contraceptives." Indeed, birth control pills are used as a way to draw women into supermarket pharmacies, and the lure is price. Oral contraceptives are sold at cost or as a loss leader at many of the leading supermarket chains, according to pharmacists.

"I don't suppose there is anybody out there who is making money on birth control pills," says Jody Stewart, director of pharmacy at Raley's, West Sacramento, Calif.

Mike Lorenzo, a pharmacist at Save Mart Supermarkets, Modesto, Calif., says he makes sure prices on birth control pills are competitive. "We don't lose any money, but it is a low profit-margin item. It is a very price-sensitive category." Oral contraceptives are not advertised in in-store circulars or newspaper inserts, but women frequently call pharmacies in their area to do some comparative shopping for the best price on a particular oral contraceptive, pharmacists reports. "Women are always calling for prices on the pills," Butts of Winn-Dixie says. "I've had customers switch to our store when I tell them that our price is cheaper." There is a narrow price range for oral contraceptives. Buckley of Giant Eagle, for example, says the price for a 28-day pack of birth control pills sold at his pharmacy ranges from a low of $17.99 a month to a high of about $22 a month. Other pharmacists concur that prices for birth control pills are within a fairly narrow range and generic brands, which account for only a small portion of sales, are only slightly cheaper than pills made by brand-name manufacturers.

Birth control pills are enjoying an upsurge in popularity, thanks in part to safer formulations and in spite of the fact that American women now have more contraceptive options than ever, including long-acting Norplant from Wyeth-Ayerst and the injectable Depo-Provera from Upjohn. But the new methods are not making any big gains in the marketplace, and birth control pills are still the most widely used form of contraception among young women.

"We have just had a few prescriptions for Norplant and Depo-Provera," says Butts of Winn-Dixie. "Since these newer methods came onto the market, I haven't seen any drop-off in our pill prescriptions. The pills have always been fast movers." After a substantial drop in sales in the late 1970s and early 1980s because of a link to heart disease, manufacturers of birth control pills reformulated the product with far lower doses of estrogen and progestin, easing many concerns about safety. The pill's improved safety record started to attract more customers and birth control pills currently are used by some 11 million women, accounting for nearly 31% of all women ages 15 to 44 who use contraception in the United States, according to the Alan Guttmacher Institute, a New York-based nonprofit group specializing in reproductive health issues.

Of course, no drug is without side effects, and the pill is risky for women who smoke, as well as women with certain cancers, high blood pressure and diabetes. And every prescription for the pill must be accompanied by a patient warning label describing the side effects of the drug.

Still, young women under 25, unmarried women and those who intend to have children later continue to use the pill most frequently, largely due to its effectiveness: When properly used, the failure rate of the pill is less than 1%.

The safer formulations of low-dose synthetic hormones have helped keep sales of birth control pills rising. In 1994, chain, independent and supermarket pharmacies paid $1.2 billion to wholesalers for birth control pills, an increase of 3% over the year earlier, according to IMS America, Plymouth Meeting, Pa., a unit of Dun & Bradstreet, New York. Because most retailers sell the pills at cost to consumers, retail sales are only slightly higher.

This year sales are showing some robust growth, too. For the first eight months of the year, sales of birth control pills at the wholesale level reached $715 million, an increase of 8% from the same period a year ago, according to IMS.

Manufacturers of birth control pills have made a big effort to aggressively market the new low-dose hormone pills, even at the expense of their own brands. Ortho Pharmaceutical Corp., Raritan, N.J., a unit of Johnson & Johnson, markets Ortho-Novum 7/7/7, for example, the leading brand of birth control pills in the United States. But the brand, which commands about a 17% share of the market, has been steadily losing ground to some of the newer formulations, including those made by Ortho.

In fall 1992, Ortho introduced three new low-dose birth control pills -- Ortho-Cyclen, Ortho Tri-Cyclen and Ortho-Cept -- with an intensive marketing campaign to doctors and pharmacists. Since that time, sales of Ortho-Novum 7/7/7 have declined some 22%, from about $250 million in 1992 to $196 million in 1994. However, Ortho-Cept has proved a winner, capturing some 8% of the market in 1994, according to IMS. Indeed, Ortho-Cept was the fourth best-selling birth control pill last year. The second-leading birth control pill on the market today is Triphasil, made by Wyeth-Ayerst Laboratories, Philadelphia, a subsidiary of American Home Products Corp., New York. The product, like Ortho-Novum 7/7/7, incorporates a triple-phase design into its progestin portion to produce a wave-like effect that better imitates a woman's normal hormonal cycle. The effect can reduce breakthrough bleeding, which has occurred with older birth control pills.

Triphasil's sales have been flat over the last two years at about $135 million, according to IMS, but retailers report that the pills come in a sleek and compact package that is a selling point for some women. "The Triphasil can be tucked away in the purse, and this makes it a little bit more discreet," says Giant Eagle's Buckley. "At our store, Triphasil is the best-selling birth control pill." A big upstart in the category has been Desogen, manufactured by Organon Inc., West Orange, N.J. The product, which was introduced over the last two years, is now among the top 10 best-selling birth control pills in the United States, according to IMS. Organon has aggressively marketed Desogen, a two-phase hormone-combination birth control pill that resembles Ortho-Cept.

"We are seeing more and more prescriptions for Desogen," says Buckley. "It is one of our-lower priced brands, and it is very similar to Ortho-Cept."

In the last 10 years, low-dose estrogen and progestin combinations that have fewer serious side effects than older birth control pills have been drawing more women. However, birth control pills can have a number of serious side effects and interactions with other drugs. Pharmacists usually point out that common antibiotics can reduce the effectiveness of the pills and women should use an alternative form of contraception if they are taking, or plan to take, an antibiotic.

Lorenzo of Save Mart says he also checks his patient profile records to make sure that there is no problem with concurrent antibiotic use. He also asks if the patient may be taking any other medications.

Another common side effect -- a permanent skin rash on the face because of sun sensitivity -- should also be underscored when counseling patients, adds Winn-Dixie's Butts. "In Florida we get a lot of sun, so I warn women about sun sensitivity and tell them they can get a permanent skin rash that will pop out every time they are out in the sun. I tell them to use sunscreens and a hat," she says.

The most common question women ask is about missed pills, pharmacists say. Typically, women should take the missed dose as soon as possible and then take the subsequent pill at the normal time.

The Food and Drug Administration recently approved the female contraceptive condom, a nonprescription item, as well as the long-acting prescription contraceptives Norplant and Depo-Provera. But pharmacists say none of the newer contraceptives has made any inroads against birth control pills.

Norplant, made by Wyeth-Ayerst, contains the hormone progestin and is implanted under the skin. Its effectiveness lasts for up to five years. The device, introduced in 1991, was hailed at the time as one of the true advances in contraception. However, the product is now the target of many lawsuits, stemming in part from reports claiming the device is difficult to remove and causes serious side effects. The bad publicity has cooled enthusiasm for the product, and pharmacists say few women have the implant.

"Norplant might have made a big dent in the oral contraceptive market," says Lorenzo of Save Mart. "But it has gotten a lot of negative publicity and it isn't taking much share at all."

Wyeth-Ayerst officials could not be reached for comment.

The Method of Choice

The pill is the most popular reversible method of birth control among women. Pill use increased from 28% to 31% during the 1980s, according to the Alan Guttmacher Institute, New York. Increased use occurred among better-educated women, whites and women with higher incomes. The pill is used most often by women under 25, by unmarried women and by those who intend to have children in the future. Following is a list of various methods of contraception among men and women, along with percentages of users.

PERCENTAGE OF USERS

Pill 30.7%

Tubal Sterilization 27.5%

Condom 14.6%

Vasectomy 11.7%

Diaphragm 5.7%

Periodic Abstinence 2.3%

Withdrawal 2.2%

IUD 2.0%

Spermicides 1.8%

Sponge* 1.1%

Other Methods .4%

* The Today sponge, by Whitehall-Robins Healthcare, was taken off the market in 1995.