Health • Don't expect to find it on the aisles of the corner market.
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Every week it seems new, conflicting information surfaces about Plan B, who can buy the emergency contraceptive and where.
In April, a Reagan-appointed federal judge issued an order to make the so-called "morning after" pill available over the counter to everyone regardless of their age. The Obama administration is appealing the ruling.
To muddy matters further, the U.S. Food and Drug Administration (FDA) this month declared pharmacies can sell Plan B over the counter to teens age 15 and over, provided they show ID. Previously, anyone under 17 had to obtain a prescription.
So are Utah pharmacists who deliver mixed views on how they'll respond to the FDA's April 30 rule.
The FDA announced Teva Pharmaceutical Industries, the manufacturer of Plan B One-Step, will make their brand-name version of levonorgestrel available in the family health aisles of stores with on-site pharmacies, whether the pharmacy is open or not.
Teva also has arranged to have a security tag placed on all product cartons to prevent theft.
But don't expect to find Plan B next to the condoms or menstrual cramp cures at the corner market, not anytime soon and maybe not ever at some retailers.
'Easier to control' • Smith's Food and Drug stores, which operate 47 pharmacies in Utah, will evaluate how to market the drug when it receives the newly-labeled product from Teva, said company spokeswoman Marsha Gilford. "We will furnish [it] consistent with the FDA's regulations."
But visit a Smith's pharmacy now and you'll find Plan B behind the counter for sale without prescription to 17-year-olds and up. That's also true of Target pharmacies.
"It's easier to control it at the pharmacy than at the check stand," said Gilford.
Evan Vickers, a Republican Utah lawmaker and owner of Bulloch Drug in Cedar City, said he'll probably keep the drug behind the counter.
"We're a college town, but I can't say we sell gobs and gobs of it. We've had a few situations with underage patients who had to come in with a parent," Vickers said, noting the difficulty of asking teenagers to show proof of their age when they aren't old enough to have a driver's license.
"Whenever they're buying something like that we want to be able to counsel the patient and make sure they understand the side effects and how to take it," he said.
Reproductive rights groups, however, say a pharmacist's policing of the over-the-counter drug is tantamount to making reproductive decisions for women.
Ethical dilemmas • "I find that questionable ethically because when you're a pharmacist you shouldn't be questioning other peoples' judgment," said Karrie Galloway, director of Planned Parenthood of Utah. "You can question a prescription, whether it's going to interact with another drug. But to question the use of something sold over the counter is in most cases a moral decision on their part."
Mark Longo, a pharmacist at the independently-owned Community Pharmacy inside St. Mark's Hospital, agrees and said, "I have no moral intervention plans."
His pharmacy doesn't currently stock Plan B, but it came under new ownership this month. "I want it to be available. If people want to talk to me, I'm here. If they don't want to talk to me, I still want to make it available," he said.
Plan B One-Step, or levonorgestrel, is a single-dose pill that contains a higher hormone level than found in daily birth control pills, but it works in a similar way to prevent conception, according to the FDA, which in December 2011 declared it safe for women of any child-bearing age.
It works best if taken immediately or within three days of unprotected sex. If conception has already occurred before the pill is taken, it will not abort the pregnancy, and there is no evidence it will harm a developing fetus, according to the FDA.
Women need emergency access to the drug, and keeping it under lock inside pharmacies with limited operating hours throws up barriers, said Galloway.
The American College of Obstetricians and Gynecologists supports lifting all restrictions on Plan B.
Some doctors, however, worry about youth making critical health care decisions on their own. "These are decisions that are best adjudicated by physicians and their patients," said Matt Peterson, an infertility specialist and chairman of the Department of Obstetrics and Gynecology at the University of Utah.
Peterson declined to comment on the FDA rule, saying only, "There are a multitude of issues to address [with sexually active teens], not just an unwanted pregnancy. There are psycho-social issues and sexually transmitted disease screenings."
But Galloway said not everyone has health insurance or quick access to a doctor.
"Luckily they've got us, if they can get to us," she said, referring to health professionals at Planned Parenthood who deliver affordable, confidential care. "It would be great if everyone could talk to their parent, and we encourage them to do that. In time, most teens confide in a trusted adult."
Access issues • When Plan B was available only with a prescription, the national nonprofit was the largest purchaser of emergency contraceptives in the country, said Galloway.
Seventeen-year-old Stevie Isakson of Salt Lake City advises inquiring friends to go to Planned Parenthood for contraceptives. "They'll ask you to make a donation, but if all you have is $5 that's what you pay," she said.
But such knowledge comes too late for many of her schoolmates, she said, noting she knows of at least 10 pregnant girls at her high school.
She and her friend, Breanne Wozab, believe 12- to 14-year-olds should have open access to Plan B. "Whether their parents know it or not, kids are having sex earlier and earlier," said Wozab.
The thought of girls that young secretly obtaining Plan B strikes fear in many parents, and was cited by U.S. Health and Human Service Secretary Kathleen Sebelius as her reason for pre-empting a December 2011 proposal by the FDA to lift all age restrictions.
But studies show teens understand how to use Plan B without guidance from a health provider, that it's not for routine use and won't protect them against sexually transmitted diseases, said the FDA.
"We believe it is every woman's right," said Galloway, "to have this in her medicine cabinet should she need it."