Commentary Contraception

Buyer Beware: Can We Trust Cheap Plan B One-Step on Amazon.com?

Elizabeth Dawes Gay & Renee Bracey Sherman

Recently, social media lit up with the news that Amazon.com vendors are selling Plan B One-Step emergency contraception for as low as $16.90 plus shipping. We have to ask: How is that possible?

Have you seen people you know post on social media about super cheap Plan B One-Step? Seem too good to be true? It might be.

Recently, social media lit up with the news that Amazon.com vendors are selling Plan B One-Step emergency contraception (EC) for on average $24.99—as low as $16.90 plus shipping, and as high as $1,000. On store shelves, this product goes for around $50 a pop, so the apparent price drop is exciting news for those who want to ensure people across the country have access to this form of emergency contraception. But we have to ask: How is that possible?

In 2013, the U.S. Food and Drug Administration (FDA) approved Plan B One-Step, manufactured by Teva Women’s Health, for sale to people of all ages without a prescription and without any point-of-sale restrictions. This means that consumers do not have to go through a pharmacist or physician to obtain the product, but can purchase it directly from store shelves. While the FDA ruled in February of this year that generic emergency contraceptives could be sold on store shelves, only Teva Women’s Health’s authorized generic, Take Action, has appeared on the market. Without competition from other products, the price of Plan B One-Step has remained around $50—though when a prescription is obtained for this otherwise over-the-counter method, it is covered at no cost by health insurance under the Affordable Care Act (ACA).

It is normal for prices to vary from store to store, but such a steep drop in price raises red flags, especially since the wholesale acquisition cost (the cost for wholesalers to purchase the product from the manufacturer, Teva Women’s Health) is estimated to be $32.50 for Plan B One-Step. Wholesalers then sell the product for an estimated $39.00. Therefore, it is highly unlikely that any Amazon.com vendor would be able to acquire Plan B One-Step wholesale and sell it for $16 without taking a substantial financial hit.

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After looking into the products on Amazon.com, Reproductive Health Technologies Project (RHTP) found several vendors selling the product. One vendor, Simply Positive Supplements, sells Plan B One-Step under different descriptive names, prices, and manufacturers. In one instance, the manufacturer was listed as Women’s Capital Corporation, which is the trademark holder of Plan B One-Step that was acquired by Barr Pharmaceuticals in 2004. In other instances, it lists the manufacturer as “kwanja shop,” “Neugaugh,” and “superkrit.” Clearly, something is amiss.

Emails and phone calls to Simply Positive Supplements inquiring about its products, supplier, and the discrepancies have gone unreturned.

When RHTP inquired with the seller tarzon about how it was able to sell the product at such a low price and whether it was safe, the seller replied:

I get this at a very discounted rate and the markup in your local pharmacy is a small fortune but due to pricing on amazon we sell it at a lower price.

The seller SuNNy Side UP replied with similar comments, but stated that its product came from “a clinic.” When asked follow-up questions about its suppliers or the clinic it works with, the seller did not respond to RHTP’s emails.

Some clinics may receive Plan B One-Step at a lower cost through the federal government’s 340B Drug Pricing Program to ensure low-income patients have access to various pharmaceutical drugs, but entities that receive drugs under this program “must not resell or otherwise transfer 340B drugs to ineligible patients.” To do so would be considered fraud and a federal crime, and would also limit access to those who need it at low or no cost.

Another vendor, who operates under the name Pharmacy Consultants and sells Plan B One-Step for $16.90, replied to RHTP’s requests stating that he was a licensed pharmacist and was able to sell the product at a deep discount because of a wholesale supplier, although this information is not available on the seller page. When asked about his credentials, the vendor replied that he was a licensed pharmacist in Ohio. He was clear to note that his product “is not from [a] family planning clinic or shop lifted medication.” One review noted that the product’s box arrived opened, the foil encasing the pill was ripped, and the pill was cut in half. After the reviewer notified the seller, he sent her a new package immediately. Another reviewer noted that the product they received was close to being expired.

While we would like to celebrate the arrival of a lower-cost EC, this information gives us some cause for concern.

Plan B One-Step is a single pill taken orally with active contraceptive ingredient levonorgestrel, which works to prevent pregnancy when taken within 72 hours of unprotected sexual intercourse. If what is being sold as Plan B One-Step is actually a placebo or medically inactive pill—or if someone takes half of a pill that arrived split in half, for that matter—then consumers are still at risk of experiencing an unintended pregnancy.

As reproductive health advocates and activists, we first and foremost want to make sure everyone has access to the health care they need and that they obtain what they are actually seeking. Any issue that arises related to EC—a product that serves as the last chance to prevent pregnancy—is too important to go unquestioned. Unfortunately, it appears that some caution is warranted when seeking Plan B from Amazon.com.

It is important to share the information that people seeking EC can obtain Plan B at no cost thanks to the ACA, since all FDA-approved contraceptive methods must be covered without cost sharing (such as a copay or deductible) when prescribed. If insured, someone seeking EC can call their health-care provider and ask them to call in a prescription for ella or another EC product to a local pharmacy. They may also be able to obtain EC directly from a health clinic.

Still, consumers who do not have health insurance and for whom $50 may be unaffordable might be tempted to purchase products that are offered for $16—but they should be wary. Through our research, we could not ascertain how Amazon.com vendors are able to sell Plan B One-Step at a steep discount, or if this product is indeed what the vendors say it is. It behooves us to spread the word about the possibility that what you see might not be what you get. We must do what we can to ensure that people seeking EC obtain what is promised to them—a safe, effective product to prevent pregnancy.

While we certainly hope that market forces lower the price of EC and support expanded access and improved availability, we hope consumers will exercise some caution when seeking this important product.

Culture & Conversation Contraception

‘Carmichael Show’ Tackles Plan B Myths: ‘Stop Acting Like We’re Killing a Baby’

Cynthia Greenlee

It’s not the first time emergency contraception (EC) has made primetime, but NBC earns points for walking viewers through how to obtain and use EC, even if the episode conveys a mixed message about just how involved families should be in relatives' reproductive lives.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

On the March 20 episode of NBC comedy The Carmichael Show, 20-something couple Jerrod (comedian Jerrod Carmichael) and Maxine (played by Amber Stevens West) have a “sexual accident”: The condom breaks.

That fictional contraceptive failure gives the show, now in its second season and already known for its lighthearted treatment of heavy topics, an entrée to counter notions that equate emergency contraception (EC) with abortion, distribute correct information about how EC works, and portray a Black family frankly discussing pregnancy options.

It’s not the first time EC has made primetime. For example, VH1 reality show Love & Hip Hop: New York cast member Tara Wallace has mentioned her use of Plan B several times, including during the show’s March 21 reunion. But NBC earns points for walking viewers through how to obtain and use EC, even if the episode conveys a mixed message about just how involved families should be in relatives’ reproductive lives.

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Shortly after Maxine and Jerrod discover their condom has ruptured, the two soon arrive at the conclusion that EC—sometimes called the “morning-after pill”—is their best bet. Neither wants a child right now.

Their discussion is sitcom-brief, and the couple maintains a respectful dialogue even as they mull over the prospect of an unintended pregnancy. Jerrod defers to Maxine’s wishes. She’s calm and has a plan: “I know we’re going to be fine, because we’re going to go to CVS and we’re going to get a Plan B pill.”

Jerrod replies: “You don’t know how happy that makes me. God, emergency contraception is always the answer,” suggesting that Jerrod is familiar with EC or may have had a partner use it before.

It’s a picture-perfect scenario with relatively little stress and a quick consensus. But perhaps Jerrod and Maxine are too ideal. Some studies show that young people struggle to find out information about EC. A study published in the March issue of the Journal of Adolescent Health found that among its sample of 13- to 24-year-old boys and young men, only about 40 percent had ever heard of emergency contraception. A 2014 survey from British sexual-health organization FPA found that 43 percent of girls and women ages 16-to-54 didn’t know where to get EC if they needed it. Education wasn’t a fail-safe way of getting EC information, though EC knowledge went up with age; only 17 percent learned about EC in school or college.

So Jerrod and Maxine may be in the sweet spot of young adulthood—where they are old enough to have obtained contraceptive knowledge, are mature enough to discuss it, have enough cash to pay for it, and are not too embarrassed to seek it out.

But before they can reach a nearby pharmacy, a sudden storm forces them to take shelter at Jerrod’s family home. His parents (played by David Alan Grier of In Living Color fame and longtime actress Loretta Devine) figure out something is amiss with their son and his live-in girlfriend. Jerrod reveals the news: The two young people are anxious because, just an hour before, they realized there was a slight possibility that they could be parents.

The announcement kicks mother Cynthia (Devine) into overdrive. Affectionate but controlling, she digs out her yellowing, decades-old wedding dress to woo the couple to the marital altar. She imagines aloud her joy at being a grandmother and the possible baby as a boy she’d name Jeremiah.

As the storm keeps the Carmichaels confined in their basement, the devoutly Christian Cynthia grows increasingly shrill as she begs Jerrod and Maxine not to “have an abortion.” When Jerrod’s former sister-in-law responds to Maxine’s SOS and arrives with her own Plan B stash, Cynthia grabs the pill, flushes it down the toilet, and tells Jerrod and Maxine that now they need a “Plan C.”

Both Maxine and Jerrod remain firm with Cynthia. Maxine states that a pregnancy doesn’t require marriage these days.

Most importantly, Jerrod refutes his mother’s anti-choice rhetoric and distinguishes between abortion and EC: “Ma, Ma, stop acting like we are killing a baby. We are not. We are killing the idea of a baby.”

It’s an awkward explanation that doesn’t do much to dispel Cynthia’s protests or challenge the language of “killing.” And given Maxine’s status as a therapist-in-training who favors talking things out in her trademark wonky, almost clinical way, it’s odd that The Carmichael Show doesn’t capitalize on the character’s dispassionate communication style to help its viewers understand what EC actually does.

Still, it’s probably too much to hope that a TV comedy get in the medical weeds and explain that EC works by stopping the release or implantation of an egg. EC prevents pregnancy from happening at all, whereas abortion ends an established pregnancy.

What’s most important is that the show conveys useful basic information about Plan B: that it must be used within 72 hours of unprotected sex for maximum effectiveness, that it’s available over-the-counter, and that it’s relatively inexpensive.

Indeed, it’s the cost—cited as around $40 on the show, though some EC brands can cost less or more—that fascinates his father, Joe. He echoes Jerrod’s sentiment that EC is a technological wonder; Jerrod had told Maxine, “I don’t care if they ever cure cancer, ’cause science has done enough. They cured pregnancy, and that’s a hard thing to do. It’s so amazing.”

For his part, Joe is learning about EC for the first time. “So this B plan, it stops anything before it gets started?” he asks. “Well, get out of here. How much does this scientific achievement cost? … 40 bucks? Man, something that amazing should cost like $7,000.”

Joe’s response opens the door for further discussion, and it’s not often that we get to see men, particularly Black men, on TV talk about their feelings on fertility and fatherhood. Joe admits that after hearing decades ago that Cynthia was pregnant for the first time, he drove around and cried in his pickup truck from simultaneous excitement and anxiety. His older son talks about his apparent low sperm count and his unfulfilled wishes to have children. And as Jerrod listens to this family free-for-all about whether he and Maxine should seek emergency contraception, he begins to think that maybe he doesn’t want children in the future, either. This revelation throws Maxine off guard because she knows that although a pregnancy is not a good idea now, motherhood is definitely on her bucket list.

While Maxine’s maternal aspirations temporarily ally her with Jerrod’s judgmental and difficult mother, it’s hard to know what the show’s producers intended when they made a contraception failure into a family affair. As Maxine and Jerrod beat back their family’s objections or answer questions, the viewer wonders if the point is that young people must know their bodies, their contraceptive options, and what’s best for them when loved ones disagree? That’s a message I can get on board with. Or is it that people like Cynthia, who eventually comes around and tells Jerrod she understands their choice, can be supportive of others’ reproductive decision making? That’s important as well.

Or is it that there should be more discussion about unintended pregnancy within families or more honest dialogue about planning the family you want?

If the producers wanted to instill that last message, I’m not convinced that having the family weigh in on a predicament like Maxine and Jerrod’s, in which the pair had already clearly come to a decision based on what works best for them, sends a message I want to hear.

With a family like the Carmichaels, viewers can see why Maxine wanted the Plan B to be hush-hush. Family influence is one thing. But that influence can become coercion, and flushing someone’s contraceptives down the toilet makes for plot tension on TV, but is undeniably un-funny in real life. And though the episode ended, it’s hard to imagine that, in an actual American family, the discussion would wrap up with such a neat resolution. The idea of an entire family weighing in on a couple’s contraceptive decision sounds more like a disaster than fodder for a laugh track.

CORRECTION: This piece was updated to clarify how emergency contraception works.

Investigations Politics

In North Carolina Elections, Misleading Susan B. Anthony List Ads Star Koch Brothers Operative

Sharona Coutts

The Susan B. Anthony List is known for misleading ads. So it may come as a small surprise that a recent ad it sponsored featuring the Ryun family doesn't mention the family patriarch's long history as a Republican operative with close links to the Tea Party and the Koch brothers.

Ned Ryun and Becca Parker Ryun are a telegenic couple, who star in a heart-wrenching 65-second advertisement that targets North Carolina’s incumbent senator, Democrat Kay Hagan.

The Ryuns tell the story of their daughter, Charlotte, who was born severely premature—at 24 weeks gestation—but survived and thrived.

“I didn’t think, at 24 weeks, you could have a viable baby,” Becca tells the interviewer. “It’s a human being. It wants to live. It has a soul. It has a will. It has a desire to live,” says her husband, Ned.

The emotive video then shows images of the couple’s smiling daughter, as Ned says, “For those that are advocating late-term abortions, look at my daughter.”

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The ad finishes with the message that Kay Hagan is “too extreme for North Carolina,” due to her support for later abortions.

It’s a slick production, and a moving story, paid for by the Susan B. Anthony List, a leading anti-choice group, which announced last month that it was going on another advertising buying spree of up to $100,000, buying ads targeting Hagan, who is facing a tough battle to retain her seat in this year’s midterm elections.

The Susan B. Anthony List is known for misleading ads. In fact, earlier this year, it went to the U.S. Supreme Court to defend its right to lie in political advertisements.

So it may come as a small surprise that the ad tells only part of the story of the Ryuns, presented as an all-American couple, who could well be from North Carolina.

In reality, Ned Ryun has a long history as a Republican operative with close links to the Tea Party and the Koch brothers—context that may well change how viewers see the conclusions he and Becca drew from what was undoubtedly a deeply emotional, personal experience. Neither Ned Ryun nor the Susan B. Anthony List returned Rewire’s requests for comment.

Ned and Becca Ryun don’t live in North Carolina. The couple lives in Purcellville, Virginia, with their four children.

Ned’s father is Jim Ryun, the former Republican U.S. Representative from Kansas who served ten years in Congress. Jim Ryun is best known for his achievements as an Olympic athlete (he was a Silver Medalist in the 1,500-meter race in the 1968 Mexico City games), and for his consistently conservative views. For instance, Jim Ryun voted against No Child Left Behind, the Bush administration’s marquee education law that was intended to boost poor-performing schools. People of all political persuasions objected to the law, but not for Ryun’s reasons: He voted “no” on the basis that states should have more control over education policy and rejected the need for additional funds. This, despite the fact that Kansas has some of the nation’s lowest performing public schools, and the greatest race-based inequality in educational opportunity. He also voted to ban adoptions by same-sex couples, to ban family planning as part of US foreign aid, and against an array of reproductive rights measures. His voting record earned him a zero rating from NARAL.

Jim Ryun now runs Christian running camps, where attendees “learn how to apply racing, training strategies, and as well as hear from top Christian athletes who will share how their faith has helped them reach their fullest potential.”

It’s not just Papa Ryun who is immersed in conservative politics.

Ned himself is a former speechwriter for George W. Bush, while his twin brother, Drew, was a deputy director at the Republican National Committee.

Along with their dad, the Ryun brothers have turned Tea Party politics into a family business.

Drew and Jim Ryun are leaders of the ultra-conservative Madison Project, a group whose views of an array of things, including Europe, read more like the satirical news site The Onion.

Referring to many European countries’ policies on abortion, the Madison Project’s website says:

In Europe, the duly elected representatives in parliament decided the issue.  Being that Europe is a morally decedent leftist utopia, they elected politicians who reflect their values.

Ned heads up American Majority Inc., a 501(c)(3) nonprofit entity whose goal is to “create a national political training institute dedicated to recruiting, identifying, training and mentoring potential political leaders.”

While it claims to be non-partisan, American Majority Inc. says it is committed to promoting “individual freedom through limited government and the free market.” In reality, that has mostly meant the Tea Party. Ned even wrote a monthly column in The Spectator called “With the Tea Partiers.”

Like the brothers, American Majority Inc. has a twin—a 501(c)(4) called American Majority Action, which is led by Drew.

Together, the American Majority organizations have donated to numerous Tea Party groups across the country, according to the entities’ tax filings. In 2010 the American Majority apparatus gave $520,000 to radical groups, including $22,500 to the St. Louis Tea Party in Missouri; $5,000 to the Jefferson County Tea Party in Missouri; and $275,000 to Grassroots Outreach, a Tempe, Arizona-based firm that has been linked to voter fraud.

They have also made multiple donations to so-called 9/12 Project associations. The 9/12 Project is linked to Glenn Beck, and its goals include “tak[ing] over the Republican Party.”

The American Majority nonprofits are licensed to do business in at least 34 states, and have drawn controversy for tactics such as paying field staffers in Ohio up to $10 an hour to get out the vote during Mitt Romney’s 2012 campaign. Traditionally, field canvassers have been volunteers.

Just as interesting as who gets money from American Majority is who has donated to the Ryuns’ political operations.

An analysis by Rewire, based on numbers collected by the Center for Media and Democracy, shows that American Majority received $3.9 million from DonorsTrust and its affiliated entity, the Donors Capital Fund, between 2010 and 2012. That puts American Majority among the top 15 recipients of DonorsTrust funds.

DonorsTrust is one of the largest pass-through entities for conservative giving. Essentially a legal form of money laundering, DonorsTrust facilitates contributions from anonymous donors to be channeled toward conservative groups they specify. The Center for Media and Democracy names DonorsTrust as a key component of the Koch brothers’ political web.

Between 2010 and 2012, the Donors entities distributed $252 million to a wide range of groups, including the Koch brothers-affiliated Americans for Prosperity Foundation, the Mercatus Center (a bastion of libertarianism, partly founded by the Koch brothers, according to Daniel Schulman’s recently published history of the Koch family, Sons of Wichita), and the right-wing Franklin Center for Government and Public Integrity.

And the Ryuns’ connections to the “Kochtopus” don’t end there.

According to The American Spectator, the idea for the American Majority groups “was conceived” by the Sam Adams Alliance, an organization that was active from 2007 through 2011, whose mission was to encourage “citizen engagement in politics, with specialties in studying and training citizen activists and bloggers.”

The alliance was headed by long-time ultra-conservative and libertarian Eric O’Keefe, who has been close to the Koch brothers for decades. According to his online biography, O’Keefe worked on the Libertarian Party presidential campaign in 1980, in which David Koch was drafted by his older brother, Charles, into running as the vice presidential candidate.

O’Keefe became close with another member of the Kochs’ inner circle, Ed Crane, who ran at the top of the Libertarian Party ticket and then spent the next few decades leading the Cato Institute, the extreme “free market” think tank that was almost entirely funded by the Kochs. O’Keefe joined Cato’s board in 1988. According to the Center for Media and Democracy, O’Keefe also worked for a group called Citizens for a Sound Economy, which was the predecessor to the Koch’s new funding vehicle, Americans for Prosperity.

Thanks to O’Keefe’s ideas about training citizen activists, the Ryuns are now emerging as potential rivals to Karl Rove, and his enormous political machine, as masters of the “shadow” conservative movement, where power is held not by elected representatives, or even by the Republican National Committee, but by a cadre of highly paid consultants and deep-pocketed donors.

In addition to American Majority, the brothers have established at least two other entities that feed into the extreme right’s political infrastructure.

In 2012, American Majority reported using nearly $900,000 from its nonprofits to support a new outfit, called Media Trackers, a site that says it is “dedicated to media accountability, government transparency, and quality fact-based journalism.”

In reality, Media Trackers has made claims about voter harassment in Wisconsin that PolitiFact later found were “mostly false,” and the group was active in attempting to undermine the Wisconsin effort to recall Gov. Scott Walker.

Media Trackers is “a project” of another nonprofit entity with the Orwellian name Greenhouse Solutions. Tax filings show that Ned’s brother, Drew, and their father, Jim, are on the board. (It’s noteworthy that of the three bills noted by American Majority Action in its 2011 tax filings as particular lobbying targets, one was the NATGAS Act, a bipartisan measure intended to support natural gas. The name “Greenhouse Solutions” appears to literally be the opposite of what the Ryuns work toward.)

RyunsHowever, perhaps the Ryuns’ most promising new entity is a voter database company known as Gravity. (It goes by iterations of that name—sometimes called Political Gravity, and sometimes, Voter Gravity.)

Political parties increasingly rely on sophisticated voter databases to win elections, and they’re willing to pay high premiums for the best data, and those who know how to wield it.

In the aftermath of Mitt Romney’s loss in the 2012 presidential race, the relative inferiority of his team’s database—known as Orca—became a key sore point for Republicans. Since then, competing teams in the shadow conservative world have been racing to build new systems to match up with the Democratic Party’s data tools—and with each other. Politico last year reported that the Koch brothers have established a political data company called i360, while Karl Rove’s group, Liberty Works, is also putting together a platform—each attempting to build the dominant conservative data tool.

And then there are the Ryun twins, whose Gravity platform was expected to pass 1 million voter contacts by late 2012, propelling them into the financial center of right-wing politics.

The company’s website boasts that “while Romney’s ‘Orca’ was going belly-up on Election Day, another group of conservatives were enjoying the fruits of labor that began long before voters headed to the polls.” Increasingly, they are being taken seriously as highly connected conservative heavyweights.

While none of this detracts from Ned and Becca Ryun’s experience with the premature birth of their daughter, it does change the way viewers might see the conclusions that the couples drew from that experience.

The Ryuns are far from being “everyday” North Carolinians. They are ensconced in the ultra-conservative movement, and their income derives from convincing the public of their very particular worldview.

It would be fair to say that, if North Carolina voters knew the reality of who the Ryuns are, they’d be less inclined to see Kay Hagan as an “extremist,” and more likely to look closely at what the Ryuns believe.

Moreover, Ned Ryun’s failure to disclose his conflicts of interest raises questions about how much trust can be placed in the views he expresses.

Not only did he and the Susan B. Anthony List neglect to mention Ned’s extensive Koch brothers connections, but neither group mentioned that they had worked together in the past, when they both helped to launch Ohio Life and Liberty in October 2012. Nor did Ned disclose that the Susan B. Anthony List had contributed $28,000 to his father’s political campaign. (Koch Industries contributed more than $86,000.)

But Ned Ryun’s failure to disclose even extends to his interest in Voter Gravity.Ned.Ryun.on.Political.Gravity

On the company’s Facebook page, a reviewer purrs about the quality of Gravity’s service: “It was a bit of a no brainer for me to use Voter Contact: They saved me lots of money and got me a better product.”

The reviewer gave Voter Gravity a five-star rating.

Political Gravity’s account then replies, “Thank you Mr. Ryun.”

That’s right. That reviewer was Ned Ryun, who replies—possibly to himself—“You bet. This is good stuff.”

If the Ryuns’ entity, Media Trackers, is intended to police truth in the media, perhaps they should take a look at themselves. Surely they’d see no conflict of interest with that, either.

Sofia Resnick contributed research to this report.