If you’ve had unprotected sex and don’t want to become pregnant, you may be looking for emergency contraception. The “morning-after pill” is a safe and effective option.
Levonorgestrel morning-after pills, like Plan B, are arguably the most well-known emergency contraceptives. Other options include the Ella pill and the copper intrauterine device, more widely known as an IUD.
These emergency contraceptives “won’t have an impact on an existing pregnancy, they prevent a pregnancy from occurring,” Dr. Meera Shah, chief medical officer of Planned Parenthood Hudson Peconic in New York, told USA TODAY.
Plan B and other levonorgestrel pills can often be the easiest to access – as you can buy them at local drug stores or online without a prescription.
Still, challenges in accessing this kind of emergency contraception continue – and the barriers aren’t equal for everyone. Plan B’s $40 to $50 price tag is unaffordable for many. Conscience clauses in some states allow pharmacists to refuse selling the pill. And, for people over 165 pounds, levonorgestrel can be less effective.
In the wake of the Supreme Court’s Friday decision that ended the constitutional right to abortion, people across the U.S. can still buy and access emergency contraception like morning-after pills. But many fear what the reversal of the 1973 landmark Roe v. Wade case could mean for other rights protected under the right to privacy, including contraception as a whole.
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Where can you get Plan B? How effective is it? What’s the future of contraception access now that Roe is reversed? Here’s what you need to know.
What is Plan B?
A morning-after pill is an oral emergency contraception that you can take up to five days after unprotected sex (including if your method of birth control failed, such as a ripped condom or missing a birth control pill) to reduce risk of pregnancy.
There are two types of morning-after pills: levonorgestrel pills and the ulipristal acetate-based Ella pill. Plan B One-Step, or Plan B, is arguably the most well-known levonorgestrel pill in the U.S.
According to Planned Parenthood, taking a levonorgestrel morning-after pill within three days of unprotected sex can lower your chance of getting pregnant by 75-89%. In addition to Plan B One-Step, common brands include Take Action, Preventeza, AfterPill, Aftera, My Choice, My Way, Option 2 and EContra One-Step.
Where can I get Plan B? Is it only over the counter?
You can get Plan B or other levonorgestrel pills at your local drug store or pharmacy. You can also order some levonorgestrel pills online, if time allows, or try going to a nearby family planning clinic or health center.
Levonorgestrel can be purchased over the counter without a prescription in the U.S. It’s often locked or kept behind the counter, so you may have to ask a pharmacist or store clerk for assistance.
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How can I get Plan B for free? Is it covered by insurance?
The price of Plan B typically ranges from $40 to $50, but you can order some generic brands for less. The brand shouldn’t matter – Planned Parenthood notes that all brand-name and generic levonorgestrel morning-after pills are equally effective.
Still, “cost is the big barrier,” Shah said, adding that it’s important to know options to help with the price if needed.
Health insurance may aid with the cost. You can get morning-after pills for free with many insurance plans, including Medicaid in some states. But if you’re using insurance, it’s important to note that you will need a prescription by doctor or nurse so that the pill will be covered. Call your provider to confirm.
Some health centers, including Planned Parenthood, also offer morning-after pills for free or at lower costs.
Shah recommends buying one or two morning-after pills or getting a prescription in advance, that way you are prepared when you need it. Still, it’s important to note that these pills can expire, so check the information on the side of the box.
Do I need to be 18 to buy Plan B? What are conscience clauses?
No. You should be able to buy Plan B and other levonorgestrel morning-after pills no matter what age you are.
However, some state laws can cause barriers in access. “Conscience clauses,” for example, give pharmacists and other health care providers the right to refuse filling emergency contraception and contraception prescriptions if it violates their religious or personal beliefs.
According to the National Conference of State Legislatures, conscience clauses were first enacted across numerous states in response to the landmark Roe decision, allowing physicians to refuse to perform an abortion and hospitals to ban abortions performed on their premises. Protections for refusing to distribute emergency contraception, including morning-after pills, soon followed.
Conscience clause legislation can vary between states, but some states with these kind protections include South Dakota, Idaho, Arizona and Texas.
How soon should you take Plan B? How does the pill work?
Despite the name, you don’t have to take a morning-after pill in the morning directly after having unprotected sex. You can take Plan B and other levonorgestrel pills up to five days after, but the sooner the better. Planned Parenthood notes that it works best to take a levonorgestrel pill within three days of unprotected sex.
In basic terms, a levonorgestrel morning-after pill is a hormone-based contraceptive that prevents or delays ovulation, which is when an egg is released from the ovary. It’s like a highly-concentrated birth control pill, Dr. Mary Jacobson, an obstetrics-gynecologist and chief medical officer at Alpha Medical, previously told USA TODAY.
The pill is very safe, but there can be some mild side effects. According to the Mayo Clinic, side effects can include nausea, fatigue, headache, bleeding between periods or heavier menstrual bleeding.
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You cannot take Plan B too much, Shah notes, because it will just continue to delay ovulation. Planned Parenthood says it’s “totally safe to take the morning-after pill as many times as you need to” – but adds that it might not be the best form of a go-to contraception in the long term due to the financial cost, some of the side effects and because other types of birth control (such as condoms and the IUD) may be a better fit.
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Morning after pills like Plan B are “a great form of contraception,” Shah said. “What I tell people though, is that if you’re finding that you’re using it so often, it may be a good idea to think about something that it is more consistent just in terms of lifestyle.”
Is Plan B effective for people over 165 pounds?
Unfortunately, it’s important to note that Plan B isn’t equally effective for everyone – further limiting options for many in accessing emergency contraception. According Planned Parenthood, levonorgestrel pills may not work for people who weigh 165 pounds or more.
If you weigh more than 165 pounds, a morning-after pill containing ulipristal acetate, or Ella, may be best for you. However, unlike levonorgestrel morning-after pills, you will need a prescription to buy Ella.
Ella can reduce risk of pregnancy by 85% if taken within five days after unprotected sex (the sooner the better, like Plan B), Planned Parenthood says. If you’ve already taken Ella but later need emergency contraception again for unprotected sex in the following five days, you will need to take Ella again – not a levonorgestrel pill. Levonorgestrel is a type of progestin (similar to what is used in birth control pills), whereas Ella is a progestin blocker.
“What you shouldn’t do is combine Plan B and Ella,” Shah said. “They have opposite methods of action, so they can, in theory, negate each other.”
If you weigh 195 pounds or more, Ella still might not be as effective, according Planned Parenthood. A copper IUD, which can be used as another form of emergency contraception if inserted up to five days after unprotected sex, may be a better option. Talk to your doctor about what is best for you.
Could the end of Roe v. Wade impact access to emergency contraception?
On Friday, the Supreme Court overturned Roe, the 1973 landmark case that constitutionally established the federal right to abortion, in its closely-watched Dobbs v. Jackson Women’s Health Organization ruling.
The reversal could cause at least 26 states to ban abortion, according to the Guttmacher Institute. 13 of these states have “trigger laws,” which are now set to go into effect automatically or through a quick state action because Roe no longer applies.
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The Supreme Court’s reversal of Roe could eventually have impacts beyond abortion rights, experts warn. Roe established the right to abortion under the right to privacy, bringing into question what the reversal could mean for other landmark rulings that also used the right to privacy – including same-sex marriage, interracial marriage and, again, contraception.
In a concurring opinion written by Justice Clarence Thomas, he noted that cases including Griswold v. Connecticut (which established the right for married people to obtain contraceptives), Lawrence v. Texas (which established the right to private, consensual sexual acts) and Obergefell v. Hodges (which established the right to same-sex marriage) “are not at issue” right now.
However, Thomas wrote, “In future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell.”
People across the U.S. can still buy and access emergency contraception like morning-after pills – but many worry that abortion bans and restrictions could trickle down to other forms of contraception in the future.
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The right to privacy “comes from a number of different areas within the Constitution itself, but it evolved out of a right to contraception access. And from that we got a whole slew of sexual privacy rights,” Anthony Michael Kreis, a law professor at Georgia State University College of Law, told USA TODAY in May, following the leak of the court’s draft Dobbs opinion. “So, if you unravel one string in that fabric of doctrine, it could potentially unravel the other rights or at least open them up to greater attack.”
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Contributing: Adrianna Rodriguez, Bill Keveney, USA TODAY.
