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Massachusetts rules improve access to emergency contraception
Massachusetts rules improve access to emergency contraception

A statewide standing order policy in Massachusetts resulted in a significant increase in emergency contraception orders at pharmacies compared to the results of similar orders in other states, a recent study shows. JAMAICA.1

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Emergency contraception is essential to prevent pregnancy after unprotected sex or contraceptive failure. Medications can be taken several days after contraceptive failure and still prevent pregnancy by inhibiting ovulation.2

The first oral emergency contraceptive available in the United States was a tablet containing the progestin levonorgestrel. Progestin-based emergency contraceptives are most effective when taken within 72 hours of unprotected sex, reducing the risk of pregnancy by 81 to 90%.2

Ulipristal (Ella), a selective progesterone receptor modulator, can also be used as emergency contraception and has been available in the United States since 2010. It is a single-dose pill that remains effective in preventing pregnancy for up to 5 days after unprotected sex. Neither progesterone-based pills nor ulipristal are associated with serious side effects.

Recent restrictions on abortion access across the country have increased the need for greater access to emergency contraception. To address this issue, Massachusetts has implemented a statewide standing mandate for emergency contraception.1

The standing order allows pharmacists to dispense prescription ulipristal and over-the-counter levonorgestrel (Plan B). Pharmacists in 27 states are permitted to prescribe oral contraceptives, but they require additional training to do so.

The new study examined the relationship between reducing barriers to access to medication and making emergency contraception available in pharmacies.

The statewide order for Massachusetts was issued in August 2022. Investigators compared changes in emergency contraceptive refills between July 2021 and May 2022 with those documented between August 2022 and December 2023. All changes were assessed using a quasi-experimental difference-in-differences design.

RESULTS

The primary outcome of the analysis was monthly emergency contraceptive use rates, while ulipristal and levonorgestrel prescriptions were secondary outcomes. Results were reported per 100,000 women aged 15 to 49 years.

The final analysis included 92,500 emergency contraceptive prescriptions from July 2021 to October 2023. Prior to the implementation of the standing prescription, Massachusetts experienced a slight increase in emergency contraceptive prescriptions compared to the comparison states, but overall trends were similar.1

Before the standing order, a use rate of 78.5 emergency contraceptive uses per 100,000 women was reported. After the standing order, the use rate was 105.3 uses per 100,000 women. This represents an increase of 26.8 uses per 100,000 women.1

In the comparison states, the rate of emergency contraception dispensing was 45.8 dispensings per 100,000 women before the implementation of a statewide standing prescription and 48.4 dispensings per 100,000 women after the implementation. In Massachusetts, there were 25.2 additional emergency contraception dispensings per 100,000 women compared to the comparison states in the adjusted difference-in-differences analysis.1

For ulipristal, there were 31.6 additional prescriptions per 100,000 women in Massachusetts compared to the comparison states. However, no significant differences were observed for levonorgestrel prescriptions, which were -6.4 prescriptions per 100,000 women.

These results showed a 32 percent increase in the number of emergency contraceptives dispensed in Massachusetts pharmacies compared to comparison states, as well as a switch from prescription levonorgestrel to ulipristal. The researchers concluded, “Policies that reduce barriers to prescribing can improve access to emergency contraception, particularly ulipristal.”1


Findings from the study

  1. Massachusetts’ statewide standing order policy resulted in a 32% increase in pharmacy dispensing of emergency contraception compared to other states.
  2. This measure led to a significant shift away from prescription levonorgestrel towards ulipristal as a means of emergency contraception.
  3. The standing prescription allows pharmacists to prescribe both over-the-counter levonorgestrel and prescription ulipristal, thereby removing barriers to access.
  4. The study used a quasi-experimental difference-in-differences design to evaluate changes in emergency contraceptive refills between July 2021 and December 2023.
  5. Before the implementation of this policy, the rate of emergency contraception administration was similar in Massachusetts and the comparison states, but the permanent order resulted in 25.2 additional administrations per 100,000 women in Massachusetts.

References
1. Qato DM, Guadamuz JS, Myerson R. Changes in emergency contraceptive refills under the Massachusetts statewide standing order. JAMA. Published online on 2 July 2024. doi:10.1001/jama.2024.11715
2. Emergency contraception. Women’s health policy. KFF. August 4, 2022. Retrieved June 3, 2024. https://www.kff.org/womens-health-policy/fact-sheet/emergency-contraception/

By Aurora