A woman in Costa Rica who needs to get the drug Posterga, popularly known as the morning-after pill, will not have an easy task.
She may have to visit several pharmacies until finding one that does not put conditions on the sale. This was confirmed by Semanario Universidad in a tour of 16 pharmacies in Cartago and San José.
Of pharmacies visited in the cantons of Cartago, Tres Ríos, Curridabat, Goicoechea and Montes de Oca, seven sold the pill without any problems and without major questions; five did not market it at the discretion of the regent on duty or pharmacy ideology; three said they were sold out; and in one the pharmacist asked several questions and tried to “raise awareness” about the use of the drug.
According to the Ministry of Health, which authorized the availability of the drug earlier this year through a decree, the sale of products in private pharmacies is a “proper matter” of the owner of each business and its commercial relationship with the laboratory, product manufacturer or its representative. That is, it is not up to the Ministry of Health to establish sanctions in this situation.
“The Ministry of Health must ensure that the pharmacy has its current certificate of qualification and that the pharmaceutical products that are sold are previously registered,” was the response through its Press Department.
The president of the College of Pharmacists, José Gatgens, said they have not currently received complaints about pharmacies that choose not to sell the morning-after pill. However, he stressed that the College is working on an approach guide for the pharmacist to give better patient care.
“It is not a matter of influence, but of technical, scientific elements to be able to conduct the interview better,” he said. “If the patient is open to give some type of information — it can be given, always with respect and dignity for the person.
“A patient who comes to use this medication can be instructed on how she is handling her planning and that this is for use in an emergency, but she can better plan.”
For its part, the director of the Asociación Ciudadana Acceder (Citizen Association for Access), Larissa Arroyo, said they also have received no complaints about this issue. But she said it is more important that social security provides the pill, regardless of pharmacy behavior.
Currently, the morning after pill is only available at private sector pharmacies; however, the Costa Rican Social Security Fund (CCSS, or Caja) is working to include this medicine in the Official Drug List (LOM).
According to the coordinator of the program of normalization of HIV and sexually transmitted infections of the CCSS, Gloria Terwes, there is a team that is making a note to the Pharmacotherapy Committee of the institution to endorse the drug and include it in the official list.
“The Caja is making an official note to the Pharmacotherapy Committee. The Committee is the one that reviews and approves requests for medications that are not on the official list. What the technical team has to carry is a note based on why the morning after pill has to be included. That is being managed because for the Caja it would be better to use the morning-after pill than the Yuzpe method, because it is a single pill, it is easy to take, you have to inform very well, but explain very little how it is taken,” Terwes said.
The coordinator said she does not know when this request will be submitted to the Pharmacotherapy Committee.
Many conditions and high prices
From the pharmacies we visited, it is possible to deduce that the big chains such as Fischel, Sucre and Farma Value offer the pill and often do not put more obstacles to obtain the medicine. However, they show great difference in prices.
For example, the pharmacy Sucre in Cartago sells the tablet at ₡20,300, the Fischel in Curridabat at ₡18,530 and Farma Value in Cartago at ₡15,650 (lowest price of our tour).
The AMPM pharmacy located in Tres Ríos has the highest price: ₡25,000. If you compare the price of the Posterga pill with that of Farma Value in Cartago, the difference is ₡9,350 (about $16).
At the La Bomba pharmacy located in Cartago, the pharmacist in charge that day said that while the store had the pill, it was his decision not to sell it.
Another of the striking cases occurred in Farmacenter in Tres Ríos, where the regent said that the establishment refuses to sell the pill because it “is not within the thinking of the pharmacy.”
In the Botica García pharmacy located in the center of Cartago, the pharmacist tried to raise awareness about the use of the tablet — asking why the buyer did not use contraceptives and if it was the first time she had used the pill, among other questions. The price of the drug in the establishment is ₡19,100.
Situations such as those described also happened to others who reported that they toured several pharmacies and could not buy the pill. (Names were changed in this section of the story.)
Jimena said she visited four pharmacies at the beginning of September and was unable to obtain the medication. According to the young woman, one of the pharmacies had chosen not to sell the morning-after pill, while in the others it was apparently sold out.
The last pharmacy that Jimena visited was the one located within the Tres Ríos Automercado, where they told her that she would have to travel to Nicoya to purchase the pill.
“I gave up and came to my house because of all the pharmacies that were around me none had and I was not going to Nicoya,” she said. “In the end, I did nothing because I was not so nervous; it was more a precaution.”
Alejandra experienced a similar situation three weeks ago. She visited four pharmacies in La Fortuna de San Carlos to try to get the pill for a U.S. tourist.
According to Alejandra, of the four establishments visited, three of the pharmacies told them that they had “no plans to sell it,” while at Fischel it was sold out and wouldn’t be available for a week.
“She (the U.S. tourist) was very surprised, she was surprised that she had to use the Yuzpe method when there is a pharmacological alternative to do the same,” Alejandra said. “She didn’t think Costa Rica was like that. She had the image that this was a progressive country for the region and the world, and did not think this situation was possible.”
The young woman said that after the search, the tourist chose to undergo the Yuzpe regimen — taking enough regular contraceptive pills at once to prevent a pregnancy — which often becomes the only emergency contraception option for women.
A version of this story was originally published by Semanario Universidad on September 17, 2019. It was translated and republished with permission by The Tico Times. Read the original report at Semanario Universidad here.