Plan B Does Not Require an Inpatient or In-Person Visit
No, a patient does not need an inpatient or in-person visit to obtain Plan B (levonorgestrel emergency contraception). Plan B One-Step is FDA-approved as a nonprescription, over-the-counter product available to all women of childbearing potential without age restrictions or proof of age requirements 1.
Over-the-Counter Availability
- Plan B One-Step (levonorgestrel 1.5 mg) can be purchased directly from pharmacies without a prescription or healthcare visit 1.
- Generic levonorgestrel versions are also approved as nonprescription products for individuals aged 17 years and older, though proof of age is not required for purchase 1.
- This over-the-counter status was specifically designed to reduce barriers to emergency contraception access, recognizing that timely use is critical for effectiveness 1.
Clinical Recommendations for Access
- Healthcare providers should discuss emergency contraception with all patients during routine care and consider advance provision, as this is recommended as part of routine adolescent and reproductive health care 1.
- The American College of Rheumatology strongly recommends discussing emergency contraception use with all patients, including those with complex medical conditions, because the risks of emergency contraception are low compared to those of unplanned pregnancy 1.
- Levonorgestrel has no medical contraindications to use, including in patients with thrombophilia or other high-risk conditions 1.
Important Clinical Considerations
- Levonorgestrel emergency contraception should be taken as soon as possible after unprotected intercourse, ideally within 72 hours, though it can be used up to 5 days (120 hours) post-coitus 1, 2.
- Efficacy decreases with time, preventing approximately 85% of pregnancies when used promptly 1.
- No pregnancy test is necessary before using levonorgestrel emergency contraception, as it does not have teratogenic or adverse effects on an established pregnancy 1.
Weight-Based Efficacy Concerns
- Levonorgestrel emergency contraception loses effectiveness in women weighing more than 165 pounds and may be ineffective in women weighing more than 176 pounds 1.
- For patients in this weight range, ulipristal acetate may be more effective, though it requires a prescription 1, 3.
- The copper IUD is the most effective emergency contraception option regardless of weight but requires a healthcare visit for insertion 1, 3.
When a Healthcare Visit IS Indicated
While Plan B itself requires no visit, patients should seek medical care if:
- They weigh more than 165 pounds and want to discuss more effective alternatives like ulipristal acetate or copper IUD 1, 3.
- They do not have a withdrawal bleed within 3 weeks after taking emergency contraception, as a pregnancy test is then recommended 3.
- They are taking certain antiretroviral medications (such as efavirenz) that may reduce levonorgestrel levels, though efficacy data in this context are limited 1.