Enhancing access to emergency contraception: Results from a no-cost program in Utah

Abstract

Objective

We assessed no-cost uptake of the two FDA approved emergency contraception methods via University of Utah pharmacies.

Study Design

In January 2023, we began providing levonorgestrel 1.5 mg (available over the counter) and ulipristal acetate 30 mg (requires a prescription) to Utah residents aged 18+ (complying with University interpretation of state law), without cost or gender restrictions. A limited informational campaign informed people they could access up to three doses of each emergency contraception type through the University’s MyChart patient portal, without requiring prior provider visits. The portal provided information about both emergency contraception options including greater efficacy of ulipristal acetate. Requests underwent advanced practice clinician review, prescription preparation and fulfillment. Medication pickup occurred at any University of Utah pharmacy location in-person or through mail delivery system. We analyzed de-identified electronic health record data to assess user demand, demographics and emergency contraception preference.

Results

During the two-year study period, we received a total of 2559 requests, 1279 in 2023 and 1280 in 2024. We provided 1094 individuals (42.8%) with levonorgestrel 1.5 mg, resulting in 2318 dispensed pills and 1465 individuals (57.2%) with ulipristal acetate 30 mg resulting in 3259 dispensed pills. Most levonorgestrel (690/1094, 63.1%) and ulipristal acetate (981/1465 67.0%) users requested multiple doses. In-person pharmacy dispensing increased from 860 recipients (67.2%) in 2023 to 1001 (78.2%) in 2024 (p < 0.001) with corresponding shipments decreases across 13 Utah counties.

Conclusion

Eliminating cost and provider visit barriers resulted in sustained demand and patient preference for ulipristal acetate, the more effective emergency contraception method.

Implications

This study supports removing cost and access barriers to emergency contraception, showing high demand for ulipristal acetate, and sustained use when offered without provider visits. This model demonstrates an innovative and feasible approach to deliver equitable access across diverse populations and regions via electronic portals and mail delivery systems.