Japan initiates a groundbreaking market test of over-the-counter emergency contraceptive pills with pharmacies as a first access point

On 28 November 2023, the Japanese Ministry of Health, Labor and Welfare (MHLW) initiated a market test to allow designated pharmacies to sell emergency contraceptive pills (ECPs), levonorgestrel (approved in 2011 in Japan) or its generic product, behind the pharmacy counter without a prescription.1 The test, commissioned by the MHLW and conducted by the Japan Pharmaceutical Association, will run until at least March 2024, evaluating the future possibility of switching ECPs to either behind-the-counter (BTC) or over-the-counter (OTC) medication. Individuals who consent to participate in the investigative research can administer the pill in front of the pharmacist subsequently after the instruction. The official website estimates the ECP to cost around Japanese yen ¥7000–9000 (US$47–62), which is not covered by health insurance.

This BTC framework is epoch-making given that access to ECPs in Japan was previously limited to prescription drugs with expensive costs ranging from ¥6000–20 000 (US$40–136), which is unacceptable…

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