Emergency contraception (EC) can prevent pregnancy when taken shortly after unprotected sex. Currently there are four FDA-approved products on the market. Three of these products are approved for preventing pregnancy when taken within 72 hours after unprotected sex. One of these products, Plan B One-Step, was approved for over-the-counter sale by the FDA in 2013.

Since the late 1990s, state legislatures have taken different paths to expand access to emergency contraception. First, some states have mandated emergency contraception–related services for women who have been sexually assaulted. Second, some states permitted a woman to obtain the medication without having to obtain a physician’s prescription. Third, one state has limited pharmacists’ ability to refuse to dispense emergency contraception on moral or ethical grounds. Finally, in some states, regulations discourage pharmacists from refusing to fill prescriptions for contraceptives, with one state having gone so far as to require pharmacies that stock contraceptives to dispense all contraceptive methods. At the same time, other 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 and potentially some pharmacies, to refuse to provide contraceptive services.

Highlights

18 states and the District of Columbia require hospital emergency rooms to provide emergency contraception–related services to sexual assault victims.

• 17 states and the District of Columbia require emergency rooms to provide information about emergency contraception to sexual assault victims.
• 13 states and the District of Columbia require emergency rooms to dispense the drug on request to sexual assault victims.

8 states allow pharmacists to dispense emergency contraception without a physician’s prescription under certain conditions.

• 6 states allow pharmacists to distribute it when acting under a collaborative-practice agreement with a physician.
• 3 states, including 1 that also gives pharmacists the collaborative-practice option, allow pharmacists to distribute emergency contraception in accordance with a state-approved protocol.

3 states direct pharmacies to fill all valid prescriptions.

1 state directs pharmacists to fill all valid prescriptions.

Restricting Access

9 states have adopted restrictions on emergency contraception.

• 1 state excludes emergency contraception from the services to be covered in the state’s family planning program.
• 2 states exclude emergency contraception from their contraceptive coverage mandate.
• 6 states explicitly allow pharmacists to refuse to dispense contraceptives, including emergency contraception.
• 3 states allow pharmacies to refuse to dispense emergency contraception.

? Permanently enjoined; law not in effect.
* Pharmacists may dispense any prescription drug, including emergency contraception.
† A broadly worded refusal policy may apply to pharmacists or pharmacies, but does not specifically include them.
‡ A hospital may contract with an independent medical professional in order to provide the emergency contraception services.
? Policy does not include an enforcement mechanism.
Ψ A hospital may refuse based on religious or moral beliefs to provide emergency contraception when requested by a woman who has been sexually assaulted. However, a refusing hospital is then required to immediately transport the woman to the closest medical facility that will provide her with the medication.