GME Patient Safety Quality and Innovation Symposium

Background

Access to emergency contraception (EC) is a key component of reproductive healthcare and time-sensitive pregnancy prevention. Two commonly used EC formulations include ulipristal acetate, a prescription medication that remains effective for up to 5 days after unprotected intercourse and across a wider body mass index (BMI) range, and levonorgestrel-based EC, an over-the-counter medication that is effective at pregnancy prevention for up to 3 days after unprotected intercourse. Clinical guidelines recommend ulipristal acetate as first-line EC, particularly for individuals with higher BMI or longer delay after unprotected intercourse. However, pharmacy stocking practices may limit timely access to ulipristal acetate, potentially creating disparities for patients with higher BMI and those facing structural barriers to care. This quality improvement project sought to evaluate the availability and dispensing timelines for stocking EC across San Diego pharmacies.

Description

Study team members conducted standardized telephone calls to retail pharmacies across San Diego using a structured script (Figure 1). Pharmacies were asked whether they stock ulipristal acetate for same-day prescription pickup, and the expected timeline for availability if it needed to be ordered. Availability of levonorgestrel EC and same-day access were also assessed. Responses were recorded and analyzed using descriptive statistics.

Lessons learned or expected outcomes

A total of 129 of 132 (97.7%) San Diego retail pharmacies were able to be contacted. Levonorgestrel EC was immediately available at 82 pharmacies (63.6%), compared to ulipristal acetate at 39 pharmacies (30.2%).

Thirty-three pharmacies (25.6%) stocked both ulipristal acetate and levonorgestrel EC, while 49 pharmacies (38.0%) stocked levonorgestrel EC but not ulipristal acetate. Additionally, 41 pharmacies (31.8%) stocked neither product at the time of contact (Figure 2).

Among pharmacies that stocked ulipristal acetate EC, the average number of tablets currently stocked was 1.8 (± 1.5 SD) with a minimum of 1 and a maximum of 9 tablets available. For the 85 pharmacies where ulipristal acetate was not currently stocked, and information was available, 2 pharmacies (2.4%) reported access to ulipristal acetate the same day, 50 pharmacies (85.5%) reported availability within 24 hours, and 20 pharmacies (23.5%) reported availability within 48 hours through distributor ordering or transfer from nearby locations.

Recommendations/Next Steps

Levonorgestrel EC is widely accessible across San Diego pharmacies, whereas ulipristal acetate availability remains limited and often dependent on ordering delays. Over 63% of pharmacies stocked levonorgestrel EC while only 30% stocked ulipristal acetate, highlighting a substantial access gap between EC formulations. Even when pharmacies can obtain ulipristal acetate within 24–48 hours, delays reduce the effectiveness of this time-sensitive medication. Limited on-site inventory further constrains immediate dispensing capacity and may disproportionately affect patients with higher BMI.

Ongoing quality improvement efforts include provider education, development of a clinician-facing EC pharmacy directory, and repeat pharmacy assessments to determine whether increased prescribing demand improves pharmacy stocking and timely access to ulipristal acetate.