Over the Counter or Out of Reach? A Report on Evolving State Medicaid Policies

Plan B® emergency contraception (EC) is a safe, effective method to prevent unintended pregnancies if the tablets (two in number) are taken as soon as possible after unprotected sexual intercourse or contraceptive failure. Plan B® is most effective if taken within 72 hours, but can be used up to 105 hours after the event.1 Ensuring access to EC for all women is important, as use of EC is estimated to prevent two million unintended pregnancies and one million abortions each year.2
On August 24, 2006, the FDA announced that Plan B® could be sold over-the-counter (OTC) to women age 18 and older. More accurately, the FDA approval creates a category of ?behind-the-counter? status in which Plan B® can only be sold in pharmacies, must be kept behind the pharmacy counter, and purchasers must show a photo ID to obtain it. Significantly, however, a prescription is not required for women over age 18.3
Women under age 18 still require a prescription in order to get the drug.4 This ?duallabel? classification has raised a number of questions regarding how states are covering Plan B® for Medicaid-eligible women. 
The FDA announcement could have a significant effect on states? coverage of Plan B® for women who receive Medicaid. For example, states could implement policies that will ensure that Plan B® is available to the same extent and in the same manner for all women, including Medicaid beneficiaries. On the other hand, the FDA announcement could result in state Medicaid programs introducing policies that complicate access to Plan B® or that exclude coverage altogether for low-income women. 
Over the Counter or Out of Reach identifies the nature and extent of each state?s current written policies affecting Medicaid coverage of Plan B® emergency contraception. Advocates can use the attached chart and resource list as they determine how their state and others are 
responding to the FDA?s approval for distributing Plan B® over-the-counter. 
This report should be used in conjunction with a forthcoming publication from the National Institute for Reproductive Health, which will provide additional information about state Medicaid coverage of over-the-counter emergency contraception.5 Advocates should also continue to use the 2005 publication, Emergency Contraception & Medicaid: A State-by-State Analysis and Advocate?s Toolkit, from the National Institute for Reproductive Health, the National Health Law Program, the National Latina Institute for Reproductive Health Access, and Ibis Reproductive Health. The Toolkit provides an overview to the Medicaid coverage rules, discusses the range of issues that women on Medicaid face in accessing emergency contraception, and identifies specific steps advocates can take at the local level to address barriers to Medicaid coverage. 

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