The XX Factor

The Big Problem With Ella

At first glance, it appears that Ella , the new emergency contraception pill developed by HRA Pharma, could make Plan B, the first “morning-after pill” in the United States, obsolete. Ella works for five days after unprotected sex occurred; Plan B must be taken within 72 hours. Plus, studies show that it may be more effective than Plan B at preventing pregnancy.

So when I talked to James Trussell, director of the Office of Population Research at Princeton University and one of the most well-known pro-choice advocates in the country, I was surprised to hear him say that the didn’t think it would make much of a difference.

He thinks Ella is a great new drug and said (in theory) that he would recommend it to his own daughter if he had one. But since Plan B was approved for over-the-counter status by the Food and Drug Administration in 2006, use has skyrocketed . In the first year it was available OTC, sales doubled. And since then, obtaining emergency contraception has become as easy (for women over 17), as say, buying cigarettes: go to the pharmacy, show proof of age, pay for purchase.

But Ella’s manufacturer, HRA Pharma, didn’t even apply for over-the-counter approval because ulipristal acetate, Ella’s chemical name, is a completely new chemical entity. “Women … are not going to go to their doctor looking for emergency contraception, so how will they ever find out about it?” Trussell asked. “They’ll just go to CVS and buy Plan B one-step.”

Frugal women may take the extra step for Ella: Insurance companies that cover other forms of contraception are likely to cover emergency contraception as well , which may make a prescription drug cheaper in some cases, according to Adam Sonfield, a senior public policy associate at the Guttmacher Institute.

Even if Ella doesn’t become a blockbuster prescription drug, a new emergency contraception option, especially one that works for five days, is a big victory for reproductive health advocates. The extra two days can mean a lot for a woman if she doesn’t have easy access to a pharmacy or her pharmacist refuses to dispense emergency contraception.

And if Ella does get FDA approval, it will have one more major challenge: marketing the vague name. We call emergency contraception “Plan B” for a reason.

Photograph of Plan B courtesy of Getty Images.