Provider Briefing: Emergency Contraception Access in 2026

Emergency contraception availability has been a moving target since 2022. As a healthcare provider, you've likely fielded patient questions about whether they can get Afterpill, Plan B, or Ella — and the answers aren't always straightforward.

This briefing covers the current supply landscape for levonorgestrel-based emergency contraceptives (including Afterpill), prescribing implications, cost and access considerations, and tools you can recommend to patients who are struggling to find these products.

What Is Afterpill?

Afterpill is an OTC emergency contraceptive containing Levonorgestrel 1.5 mg — the same active ingredient as Plan B One-Step and numerous generics. It is sold directly to consumers through AfterPill.com at approximately $20 + $5 shipping, marketed as an advance-provision product (buy before you need it).

Afterpill is not distributed through traditional pharmacy channels, which is relevant when counseling patients about immediate access versus advance planning.

Supply Timeline: 2022 to Present

2022: The Demand Surge

The Dobbs v. Jackson Women's Health Organization decision in June 2022 triggered unprecedented demand for emergency contraceptives. Key events:

• Online and retail sales of levonorgestrel products spiked 500-600% in the weeks following the decision
• Amazon, CVS, Walgreens, and Walmart implemented temporary purchase limits (typically 3 units per customer)
• Manufacturer back-orders increased; some pharmacies reported weeks-long stockouts
• Afterpill.com experienced shipping delays due to order volume

2023: Gradual Normalization

Manufacturers ramped up production, and the initial panic-buying wave subsided. However:

• Rural and underserved pharmacies continued to report intermittent supply issues
• Some pharmacies in states with restrictive reproductive health legislation reduced their EC inventory
• Patient inquiries remained elevated above pre-Dobbs levels

2024-2025: Stabilization

The supply chain for levonorgestrel EC largely normalized. Generic competition increased, and new entrants helped meet sustained demand. OTC approval of Opill (norgestrel 0.075 mg daily contraceptive) in 2024 provided an additional contraceptive option, though it is not an emergency contraceptive.

2026: Current Status

As of early 2026:

• No FDA-listed shortage for levonorgestrel or ulipristal acetate
• Afterpill remains available through AfterPill.com
• Plan B One-Step and generics are widely stocked at major chains
• Ella (ulipristal acetate) is available by prescription through pharmacies and telehealth
• Localized access barriers persist in some states and rural areas

Prescribing Implications

While levonorgestrel EC is available OTC, prescribing it has practical advantages for patients:

Insurance Coverage

Under the ACA, FDA-approved contraceptive methods — including emergency contraception — must be covered without cost-sharing when obtained with a prescription. An OTC purchase without a prescription may not be covered. Writing a prescription can save patients $25-50.

Weight-Based Considerations

Evidence suggests levonorgestrel EC has reduced efficacy in patients with BMI >25 or weight >165 lbs (75 kg), and may be ineffective above 195 lbs (88 kg). For these patients:

• Ella (ulipristal acetate 30 mg) maintains efficacy at higher body weights and is effective for up to 120 hours
• Copper IUD (Paragard) is the most effective EC option regardless of weight (>99% effective) and provides ongoing contraception

Clinical note: Do not prescribe Ella and levonorgestrel concurrently. Ulipristal acetate is a progesterone receptor modulator and may reduce the efficacy of levonorgestrel (and vice versa).

Timing Considerations

Levonorgestrel EC is FDA-approved for use within 72 hours but has diminishing efficacy over time. Ella maintains more consistent efficacy throughout the 120-hour window. Counsel patients accordingly:

• 0-72 hours: Levonorgestrel or Ella both appropriate; OTC levonorgestrel may be fastest to obtain
• 72-120 hours: Ella preferred; copper IUD most effective
• >120 hours: Neither oral EC is indicated; copper IUD remains an option up to 5 days

Availability Picture for Your Patients

When patients report difficulty finding EC, consider these factors:

• Afterpill requires online ordering with shipping delays — not suitable for urgent needs
• Brand confusion — patients asking for "Afterpill" at a pharmacy may be told it's unavailable when identical products are in stock
• Geographic disparities — rural pharmacies and some states have less consistent availability
• Pharmacist refusal — some states allow pharmacist conscience clauses that can delay access

For a patient-facing explanation you can share, see our patient shortage update.

Cost and Access in 2026

Current pricing for providers to reference:

• Afterpill (online, OTC): ~$25 total
• Plan B One-Step (pharmacy, OTC): $40-50
• Generics — Take Action, My Way, EContra (pharmacy, OTC): $15-40
• Ella (pharmacy, Rx): $40-65 cash; $0 with most insurance
• Copper IUD (provider insertion): $0 with most insurance; $500-1,000+ cash

Remind patients that a prescription — even for OTC products — can activate insurance coverage and eliminate out-of-pocket costs.

Tools and Resources

Several tools can help both you and your patients navigate EC availability:

• Medfinder for Providers — Check real-time pharmacy stock for levonorgestrel and other medications. Useful for confirming availability before sending patients to a specific pharmacy.
• AfterPill.com — Direct-to-consumer advance provision at $20 + shipping. Recommend for patients who want an affordable dose on hand.
• Planned Parenthood locator — Clinics often have EC on-site at reduced or no cost.
• Telehealth platforms (Nurx, PRJKT RUBY, Planned Parenthood Direct) — For Ella prescriptions with quick turnaround.

You can also point patients to our guides on finding Afterpill in stock and EC alternatives.

Looking Ahead

Several trends are shaping the EC landscape going forward:

• Legislative uncertainty: State-level policies on contraceptive access continue to evolve. Stay current with your state medical board and pharmacy board guidance.
• Advance provision counseling: ACOG and AAP recommend counseling patients about advance provision of EC during routine visits. A proactive conversation can prevent an access crisis later.
• OTC contraception expansion: The availability of Opill and potential future OTC options may reduce EC demand over time by improving routine contraceptive access.

Final Thoughts

While there is no official shortage of Afterpill or levonorgestrel EC in 2026, access barriers remain real for many patients. As a provider, you can make a significant difference by writing prescriptions for insurance coverage, counseling on advance provision, recommending weight-appropriate options, and directing patients to tools like Medfinder when they need help finding EC in stock.

For practical workflow tips on helping patients access emergency contraception, see our provider's guide to helping patients find Afterpill.