Expanding Access to Emergency Contraception
A Toolkit to Implement a Statewide Emergency Contraception Standing Order and Emergency Contraception Vending Machines
With bodily autonomy under attack across the country, access to affordable emergency contraception has never been more important. At this moment of crisis, Massachusetts has a responsibility to expand access to critical reproductive health care and make all forms of emergency contraception more widely accessible and affordable for every Bay Stater. In July, the Legislature passed an historic reproductive health package, which included a statewide standing order for emergency contraception and a statutory fix to allow over-the-counter emergency contraception to be sold in vending machines. We are proud that this package took major steps to break down cost and accessibility barriers to emergency contraception.
The Emergency Contraception Access Expansion Toolkit includes a comprehensive assessment of the organization’s advocacy work to pass this legislation calling for a statewide standing order for both prescription and over-the-counter emergency contraception and establishing that emergency contraception can be sold in vending machines. Included as part of the Emergency Contraception Toolkit are: communications documents and talking points that were used to get the legislation passed; a copy of Massachusetts’ statewide standing order; and analysis of the successes and challenges involved. The toolkit also offers recommendations to advocates in other states for best practices when writing, advocating for, and implementing similar legislation.
A standing order is a document issued by a physician or prescriber that authorizes pharmacies to dispense medication without a prescription from a provider. A statewide standing order for emergency contraception removes barriers and makes it so that patients can go directly to their pharmacy and a pharmacist can dispense Plan B One Step® or ella® after consulting with the patient.
Other examples of standing orders allow pharmacists to give flu vaccines without needing a prescription from each individual's doctor. Similarly, the widespread roll out of the COVID-19 vaccination was made possible because of a standing order.
Why is a statewide standing order needed?
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Different People Need Different Forms of Emergency Contraception
A key feature of the statewide standing order is that it allows pharmacists to dispense both LNG-based contraception like Plan B One Step® AND UPA-based emergency contraception like ella®, based on what is best for the patient. This is important because, while Plan B One Step® is available over-the-counter, unrestricted, and without the need to show ID, this form of emergency contraception may not be the most effective for all patients. Plan B One Step® and LNG-based contraceptives are only recommended for people under 165 pounds. ella® is effective for women up to 195 pounds. ella® and UPA-based emergency contraception are not available over the counter and typically require a prescription. Having a standing order allows patients to get ella® at the pharmacy without the time-consuming step of receiving a prescription from their provider.
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Emergency Contraception is Expensive!
Emergency contraception is not cheap and cost can be a serious barrier to care. While generics of Plan B One Step® range from $35-40, the brand name typically costs $50. ella® typically ranges in cost from $50-$67. The 2017 ACCESS law required only that emergency contraception be covered if it is prescribed or dispensed pursuant to a standing order. But many pharmacists have not taken the necessary measures to procure a standing order. By creating a statewide standing order, every pharmacy would be able to offer Plan B® and ella®, and patients would be able to utilize their insurance at the point of sale—with zero cost sharing.
This will increase access, eliminate cost as a barrier, and ensure that the patient can obtain the form of emergency contraception that will work best for them without having to worry about affordability.
"A statewide standing order means that patients can access the emergency contraception that is right for them in a timely manner and take advantage of insurance coverage. With bodily autonomy under attack, ensuring affordable, prompt access to emergency contraception, without the additional step of a doctor's visit, can make a radical difference in giving people control of their lives and futures."
Rebecca Hart Holder, Reproductive Equity Now
Resources to Help Expand Access to
Emergency Contraception in Your State
Massachusetts Statewide Standing Order
To see Massachusetts’ statewide standing order for emergency contraception, CLICK HERE.
Guidance Documents for Legislative Advocacy
To find sample testimony for a statewide standing order, CLICK HERE.
To find a sample sign-on letter for a statewide standing order, CLICK HERE.
To find a Plan B® v. ella® comparison chart, CLICK HERE.
Communications Materials
To find a sample emergency contraception Q&A for advocates, CLICK HERE.
To find a sample talking points on emergency contraception access, CLICK HERE.
To find a sample one-pager, CLICK HERE.
What We Learned in our Advocacy for a
Statewide Standing Order
Other states looking to increase access to emergency contraception can use Massachusetts’ standing order advocacy as a template for their own. Specifically, REN would recommend that advocates in other states:
Institute a statewide standing order for both types of emergency contraception, rather than creating a legal and regulatory scheme where pharmacists must individually obtain standing orders;
Ensure statewide standing orders allow pharmacists to prescribe and dispense both types of emergency contraception so that patients can get what is best for them and get insurance coverage;
Maintain strong partnerships, to the extent possible, with the state Department of Health and the Board of Registration in Pharmacy;
To the extent possible, alert the state Department of Health during the advocacy process–this early notification will allow them to start the process of drafting a standing order;
To the extent possible, reach out to pharmacies in advance of the statewide standing order: let them know to be on the lookout for it and alert them that they may want to take a look at their inventories;
Enlist the Board of Registration in Pharmacy to send out newsletter and mailers altering pharmacists to the existence of the standing order;
If possible, secure funding for public awareness and pharmacist education efforts.
Admittedly, Massachusetts only recently passed this law and the standing order only recently went into effect. There will undoubtedly be wrinkles to iron out. However, because of the statewide standing order, it is now easier for patients to obtain the emergency contraception that is best for them in a timely manner, using insurance. This is an achievable victory in states beyond Massachusetts.
Emergency Contraception Sold in Vending Machines
In the reproductive health package the Legislature passed in July, Reproductive Equity Now worked to include a statutory fix to allow over-the-counter emergency contraception to be sold in vending machines on college campuses and in community centers. The emergency contraception can be sold at-cost, making this essential reproductive health care more affordable and accessible for people throughout Massachusetts.
Students are leading the way for emergency contraception access.
Students at Boston University, Northeastern University, Brandeis University, and Harvard University have already begun to implement emergency contraception vending machines on campus in student centers, breaking down serious barriers to care for college students.
