Drugstores ration Plan B contraceptives as Roe ruling sparks panic

A surge in demand in recent days for emergency contraception pills, which prompted rationing by some chain drugstores to avoid shortages, revealed the depth of fear among some in the United States after the Supreme Court upended the 50-year-old right to abortion.

Emergency contraception is a single pill taken within three days of unprotected sex to prevent a pregnancy and is not related to abortion. Yet CVS temporarily rationed orders of the pills - sold under the names Plan B and Aftera, as well as generics - amid a spike in demand since the Friday ruling. Rite Aid also limited purchases.

Emergency contraception can be purchased at a pharmacy without a prescription from a doctor. It typically costs under $50, and much less for generics. That made it a popular avenue in recent days for women who felt their options for reproductive health are under threat by the conservative Supreme Court, said advocates.

“People are scrambling to feel like they can exercise control where things feel chaotic, and it is a way to try to plan where otherwise something that normally feels stable, like the rule of law, does not feel stable,” said Nicole Huberfeld, a professor of law, ethics and human rights at Boston University. “All of these things are sort of snowballing right now.”

There also is considerable confusion about how emergency contraceptives work, as opposed to abortion pills.

Part of the fog has been caused by the Food and Drug Administration label that has accompanied the emergency contraceptive pill since 2006; the label says it blocks release of eggs before fertilization but also adds the medication can prevent fertilized eggs from implanting. Researchers have since rebutted that statement. The American College of Obstetricians and Gynecologists, in a footnoted paper on its website, says, “Review of the evidence suggests that emergency contraception is unlikely to prevent implantation of a fertilized egg.”

The FDA has previously acknowledged “emerging evidence” suggesting the drug did not prevent implantation of a fertilized egg. It has said label changes are typically sought by manufacturers. The agency did not respond to a request for comment Tuesday.

Antiabortion activists and conservative state legislators nonetheless have seized on the FDA label to brand the pills “abortifacients.” In a few cases, such as in Missouri, Idaho and Alabama, red-state legislators have proposed bills to have the contraceptive pills banned. In Idaho, student health centers at state universities are barred from carrying Plan B and generic versions of the pill, according to the National Women’s Law Center, a nonprofit that supports abortion rights.

“I really wish politics didn’t have to be part of people’s decision about contraception, but that is not reality right now,” said Mara Gandal-Powers, director of birth control and senior counsel at the law center.

Justice Clarence Thomas, in his concurring opinion overturning Roe last week, further alarmed advocates for the right to abortion when he wrote that, under the logic of the Roe reversal, the high court should consider repealing the constitutional right to use contraception, which the Supreme Court recognized in Griswold v. Connecticut in 1965.

Justice Samuel Alito, writing the 6-3 majority opinion, said the Dobbs v. Jackson Women’s Health Organization case last week was limited to overturning Roe. But abortion rights advocates are nonetheless bracing for renewed pushes by emboldened red-state legislatures to ban emergency contraceptive pills. It could take years for a case for a contraception case to make it to the Supreme Court.

Against that legal and medical backdrop, confusion and panic reigned on social media as online orders for contraceptive pills mounted. Buyers appeared to be stockpiling orders of multiple pills for potential future use for them, as well as their children.

Lauren Lopez, 38, of New York is trying to organize people on Twitter and Facebook to stockpile contraceptives such as Plan B so that they can be given to people who lack access. With last week’s Supreme Court ruling, she said she is convinced that politicians across the United States will soon try to limit birth control.

“I think in these states that have immediately banned abortion, they will take steps to prevent people from having access to emergency contraception first,” she said.

She wants to get ahead of those potential restrictions. “Before things get worse, let’s get our hands on this stuff and make sure we have it and can provide it.”

Lopez’s son has a heart condition, she said, and she has often relied on the charity of others to meet his medical needs. Her goal is to build a network of people who have access to reliable prescription birth control or can afford expensive over-the-counter pills and have them donate to people in need.

She is already active in a Facebook group that allows people to pay for one another’s legal abortion care and travel, one of several “mutual aid” groups with the goal of connecting people with potential donors.

In Michigan, 30 miles south of Traverse City, Jessica Gardner said she is considering stocking up on contraceptives. “I’m worried that younger women are not going to be able to have the decisions that in my life I took for granted,” she said.

Gardner, 51, who said she is firmly in menopause, has lived virtually her entire life under the legal protections of Roe.

“I’m concerned for people who are still in their reproductive years, who may not be able to get birth control because stores are putting limits on how much they can buy or different types of birth control could become illegal,” she said.

A CVS spokesperson said Monday that while the drugstore chain has “ample supply” of the products both online and in stores, a three-packs-per-customer cap is meant to “ensure equitable access and consistent supply on store shelves.” On Tuesday, CVS said it was putting an end to limits after sales returned to normal.

Rite Aid also is limiting purchases to three per customer, a spokesperson said Monday, also citing rising demand.

Walgreens’s website showed Tuesday that two emergency contraceptives - Plan B and Take Action - were out of stock for shipping but available for pickup and same-day delivery in certain stores. A spokeswoman said Monday that purchases were not limited at the time, as the company could still meet the demand in stores. The grocery chain Kroger noted on its website that Plan B is not available for shipping and that in-store stocks are low.

The Supreme Court on Friday overturned the fundamental right to abortion established nearly 50 years ago in Roe v. Wade, leaving states free to drastically reduce or outlaw the procedure. Thirteen states had trigger laws in place when the ruling came down, and they immediately took effect in several states, halting abortion care.

At Target and Walmart, the Plan B pill is eligible for shipping and pickup, but the time of delivery varies across locations. It can also be purchased directly on the Plan B website, but it is eligible only for four-to-six-day shipping.

As the Supreme Court ruling sent women scrambling for solutions online, tech platforms have been turned into battlegrounds for the enforcement of rules that are still highly unclear.

Mentions of abortion pills, along with posts mentioning the specific pills mifepristone and misoprostol, spiked Friday morning across Twitter, Facebook, Reddit and TV broadcasts, according to an analysis by the media intelligence firm Zignal Labs.

On Monday, Vice reported that Facebook, which has long banned peer-to-peer sales of pharmaceutical drugs, was taking down posts where people shared information about how they could obtain abortion pills by mail. In some cases the company had also temporarily disabled the accounts of people who posted the information.

Facebook spokesman Andy Stone tweeted that some of these posts had been taken down in error and clarified that people are allowed to discuss the “affordability and accessibility” of prescription medication on the platform.

Though peer-to-peer sales of all pharmaceutical drugs are not permitted, the company does allow online pharmacy businesses to facilitate transactions. But Stone told The Washington Post he could not comment on whether the company would allow online pharmacies to sell abortion pills to people in states that had banned the procedure, because there was an overall lack of clarity on whether mailing these pills is considered legal in those states.

Kate Bilowitz, a moderator for a parenting group on Facebook, said that for the time being, moderators were advising group members to use coded terms for abortion to avoid having one’s post wrongly taken down. The moderators suggested that people refer to abortion as “camping,” and the pill as “Lady M” or “camping supplies.”

Eric Feinberg, a researcher with the advocacy group Coalition for a Safer Web who had tracked online drug sales for years, said that since the draft Supreme Court ruling striking down Roe v. Wade leaked in May, numerous Facebook pages selling abortion pills had cropped up. The pages, he said, were taking advantage of people’s desperation. It was unclear whether the pages, which listed themselves as drugstores, were actually legitimate pharmacies.

Lopez, the activist in New York, hopes that the informal sharing of FDA-approved Plan B can stave off the formation of a true black market. “If we can try to provide safe care for people, maybe we can keep them from going to an unsafe and unknown source. We hope people will be filling prescriptions and donating these items.”