Why is Plan B So Damn Expensive?

As anyone who has ever scoured apartment listings in New York City is painfully aware, availability and affordability are not the same thing. If you need another example of this phenomenon, just look at the so-called morning after pill: Though women and men across the country no longer need a prescription for Plan B One-Step — this month marks the one-year anniversary of the repeal of age restrictions on emergency contraception — it's still pretty expensive. Some would argue, prohibitively so.

Luckily, according to a letter from the Food and Drug Administration, that’s about to change. Generic forms of Plan B — which currently retail at about $40, but could drop with market saturation — will soon hit pharmacy shelves without an age restriction (can I get an amen?!). After decades of litigation and lobbying, the decision is a major win for women’s health advocates. It also begs an important question: Why is emergency contraception so expensive in the first place?

Plan B, which, like other emergency contraceptives, works by delaying ovulation and must be taken within 72 hours of unprotected sex, typically sells for about $50 to $60. According to a July 2013 survey from the American Society of Emergency Contraception, more than one-third (38 percent) of pharmacies nationwide sell only the brand-name product. For low-income teens, that price point is especially punishing.

What's more, ASEC reminds us that generic Plan B isn't much cheaper than the branded version.

While moving the product from pharmacy to shelf is a tremendous step forward, price continues to be a barrier. The introduction of generics has not dramatically lowered the price of EC; while generic drugs typically cost 80-85% less than their branded counterparts, this differential is only 14% for EC products. Therefore, even the lowest price in retail outlets is out of reach of many women. To make EC truly accessible for all who need it, prices must be lowered to a more affordable level.

So why does the morning after pill — roughly the equivalent of two birth control pills — cost women more than an entire pack would?

“The price is a result of market forces, company interest and profit,” Elizabeth Gay, a program director at the Reproductive Health Technologies Project, a nonprofit dedicated to advancing reproductive freedom, tells Bustle. “I think that’s something women’s health advocates need to address in the future … The cheapest generic, AfterPill, an emergency contraceptive only available online, is only $20, which is probably an indication that the product doesn’t need to be $50.”

In an email to Bustle, Michelle Larkin, a spokeswoman for Teva Pharmaceuticals, Plan B's manufacturer, noted that the price of Plan B One-Step "has not increased" since it first appeared on pharmacy shelves in 2008. "We are committed to keeping our price the same now that Plan B One-Step is available in-aisle," she wrote.

As is common with brand name medicine, Teva was granted a three-year market exclusivity period in 2013. This is not atypical — U.S. drug makers often win exclusivity agreements under the longstanding assumption that profits from high-priced drugs fund the research that develops new, life-saving medicine.

In a May 2013 memorandum criticizing the FDA's relationship with Teva, U.S. District Judge Edward Korman stated the obvious:

While this [three-year exclusivity] proposal was a boon to Teva, it did little to eliminate the practical obstructions in obtaining emergency contraception to women of child-bearing age whether over or under age 15. On the contrary, Teva will use its privileged marketing status and exclusivity to increase the cost of the drug … if only to accommodate the more expensive packing, age-verification tags, and anti-theft technology that the new marketing arrangement would require.

The FDA has now deemed Teva's “exclusivity is too broad," opening the door for generic, over-the-counter versions that women and men of any age can purchase. There is, however, one caveat: Despite the FDA's ruling that generic versions of Plan B are safe for women of any age, legal nuances require packaging for non-Teva products to indicate the drug is only for “women 17 years of age or older.” That stamp is confusing and “strictly political,” Gay said.

As the New Republic points out :

Labeling a drug “17-and-up” when anyone can legally buy it is confusing—and uncertainty already plagues the sale of Plan B. A study released in December found that 60 percent of pharmacists surveyed were dispensing misinformation to teens who called about Plan B—and 20 percent were telling teens they couldn’t buy the drug at all. Still, access should be easier than it was before: Teens will be able to take the drug off the shelf without asking permission from the person behind the counter. Teva’s exclusivity will expire in three years—and so, hopefully, will any confusion.

“[The morning after pill is] completely safe for anyone to use, any person of any age,” Gay says. “It’s an important product that is cost prohibitive for many women, particularly women that are uninsured. [Generics] shouldn’t be restricted to anyone looking to purchase them.”

Images: Bedsider.org, Getty