By Hayase Hakariya

The Japanese government finally initiated a market test to sell emergency contraceptive pills (ECPs), levonorgestrel (approved in 2011 in Japan), or its generic product, at the designated pharmacies on 28th November 2023. This has been achieved through the long-lasting 6-year endeavours by individuals or voluntary groups to voice easier access for nationalities to ECPs. The drug is sold behind the pharmacy counter (BPC) without a prescription as a market testing commissioned by the Ministry of Health, Labor and Welfare (MHLW) and conducted by the Japan Pharmaceutical Association(JPS). This investigation will evaluate the future possibility of switching ECPs to either BPC or over-the-counter (OTC) medication.

Nowadays, 19 countries allow direct access to ECPs OTC, and 76 countries from a pharmacist BPC without a prescription, with Japan initiating the BPC method in this trial. Given that 120 000 abortions were performed in Japan in fiscal year 2022, with more than half being done by means of curettage and vacuum aspiration, it is reasonable to provide ECPs BPC via a pharmacist as an alternative method. In the recent letter, we discussed Japan’s historical background that lags behind many other countries in terms of women’s health and rights.

Upon the release of this market trial, there occurred a number of controversies regarding the issue in Japanese mainstream and social media, as this trial seemed to have very limited access to specific individual groups. Summarizing points discussed by these groups:

• Costs: The official website estimates the ECP to cost around Japanese yen ¥7000–9000 (US$45–58), which is not covered by health insurance.
• Age restriction: The trial set the limitation of the age of sexual consent at over 16 years, and minors aged 16 or 17 are required to obtain parental consent.
• A limited number of designated pharmacies: The current market test involves only 145 (<0.24%) pharmacies, although there are more than 60 000 pharmacies in Japan.
• Burdens for participants to obtain ECPs: Since the trial is conducted as a part of an investigative study, participants are also required to consent to participate in the research and answer two questionnaire surveys, once before administration and again after 3–5 weeks.

Herein, the author updates interim results of the market test, ranging 2 months from the beginning of the trial until 31st January 2024, based on the report that was published in on 10th May 2024 by Japan’s MHLW. During the 2 months of the trial, a total of 2,181 pills (with an average of 15 pills per pharmacy) had been sold. Independent from the sales quantity, the JPS obtained 1,982 individual IDs for their analysis, resulted in 1,643 (82.9%) responses in the 1st questionnaires from participants.
In this report, we find insights from participants regarding costs and their physical accessibility towards the designated pharmacy.

Of note, only 38.4 % (n=631) of the respondents marked “very satisfied” with their costs paid for ECPs, while around 90 % of them were “very satisfied” with the understandability of the pharmacists’ explanation or pharmacists’ support for their instruction. According to this report, 99.5% of participants (n=1635) paid 7,000-9,000 JPY (45 – 58 USD) for ECPs. Given their costs in the US pharmacies are around 27-34 USD and around 6 USD in the UK pharmacies, Japan should consider covering the costs i.e.) with universal health insurance, at least for individuals with specific circumstances that do not afford the cost for more secured women’s reproductive health and rights.

As for their physical accessibility, 77.4% of respondents (n=1271) were able to access the designated pharmacy within 1 hour. However, 2.0% of participants (n=33) took more than 10 hours. This implies the need for a larger-scale roll-out to leave no one behind, given that the ECPs should be administered within 72 hours after the sexual activity.

Although there remain barriers to overcome for full-scale rollout, the author underscores that this sales trial has paved a large step towards Japan’s more secure reproductive health and rights to enable women to fulfil their roles in society. To achieve a gender-equalized society, pharmacists could exert their professionality to become the first access point for all individuals, including those who are vulnerable.

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About the Author
Hayase Hakariya earned his PhD degree at Kyoto University, Japan in the field of medical science. He is a specialist in nucleic acid therapeutics and engaged as a Postdoctoral Research fellow (University of University of Tübingen) and an Overseas Research Fellow of Japan Society for the Promotion of Science (JSPS). He spontaneously organizes an Institute for Pharmaceutical and Social Health Sciences (IPhaS), a voluntary professional association, and can be contacted at haya.pha3@gmail.com