Target Corporation: Pharmacists’ Acts of Conscience and the“Plan B” Pill Case

Case On a humid and cloudy day in late September 2005, RachelPourchot entered a bright, clean, air-conditioned Target store inFenton, Missouri. She intended to fill prescriptions for OrthoTriCyclen, a common hormonal contraceptive, and for Levonorgestrel,an emergency contraceptive otherwise known as the Plan B pill.Despite Target’s reputation for efficiency, diversity, and friendlyservice, Pourchot told the Planned Parenthood Federation of America(PPF) that she left the store without the emergency contraceptive.The Target pharmacist, she claims, had rudely refused to fill herprescription on moral and religious grounds. PPF immediatelycontacted Target Corporation for comment.1 A spokesperson initiallydenied Pourchot’s account of events, and, according to PPF,declined to clearly state the company’s policy concerningpharmacists’ right to refuse. PPF launched a letter writingcampaign that led over 60,000 supporters to contact Target. Formany, the incident cast doubt on the company’s reputation as anon-discriminatory, impartial, and friendly company.2 TargetCorporation The Dayton Corporation opened the first Target store inRoseville, Minnesota in 1963. The corporation had long been notablefor its policy of giving five percent of its pretax profits back tothe community.3 In 1969, the Dayton Corporation merged with the J.L. Hudson Company. Over the next four decades, Target stores wouldbecome the Dayton Hudson Corporation’s largest source of revenue,allowing it to purchase Mervyn’s and Marshall Fields. By 1978,Target was the nation’s 7th largest retailer. In 2000, the DaytonHudson Corporation was renamed the Target Corporation. It iscurrently headquartered in Minnesota and has 1,300 stores in 47states, including 140 SuperTarget stores, which introduced upscalegrocery shopping Target customers. In addition to the expansioninto grocery goods, the company has matched growing consumer demandfor convenience by launching its bridal registry and gift carddivisions. Besides one-stop-shop convenience, aisles arewell-organized, products are attractive and stores are alwaysclean. Thus, as Target has evolved, it has earned the reputation ofbeing a no-hassle, friendly, and easy place to do everydayshopping. It boasts the most rapid revenue growth in the industryand, with a market capitalization of over $48 billion, providesWal-Mart, the world’s largest retailer, with a significant sourceof competition. Plan B Pharmaceuticals The Plan B pill is a largedose of the hormone Levonorgestrel (synthetic progestin).4Progestin is a naturally occurring hormone in the human body thatplays an important role in regulating a woman’s menstrual cycle anduterine environment. The hormone has been available for decades intraditional birth control pills, though in smaller, more regulardoses. The drug is manufactured and distributed in the UnitedStates by Duramed, a division of Barr Pharmaceuticals, Inc. Whentaken within 72 hours of sexual intercourse, Levonorgestrel willreduce the risk of pregnancy by 89 percent by stopping ovulation,or, if ovulation has already occurred, by preventing theimplantation of a fertilized egg. Patients are normally instructedto take one .75 mg tablet as soon as possible, followed by a secondtablet 12 hours later. It is important to note that the drug ismost effective when taken immediately, and becomes much lesseffective after the first 72 hours.5 The Plan B pill is oftenconfused with RU-486, or mifepristone, sometimes called the“abortion pill.” Mifepristone was first made available to Europeanwomen in 1988, though political and scientific controversy delayedits approval for sale in the United States until 2000.6 Also asynthetic hormone, mifepristone is classified as an abortifacientrather than a contraceptive. When taken during the first sevenweeks of pregnancy, the drug is intended to terminate pregnancy. Incontrast to mifepristone, the Plan B pill will not terminate anestablished pregnancy or cause any harm to a developing fetus.7 Noteveryone involved in the nation’s abortion debate recognizes adistinction between emergency contraceptives and abortifacients.The controversy came into focus on May 6, 2004, when the FDArejected Duramed’s application to make the drug availableover-thecounter. Dr. David Hager, a gynecologist from Lexington,Kentucky, testified before the FDA committee considering theproposal. Dr. Hager refuses to prescribe the pill to his patientsbecause he believes that the drug’s effects constitute chemicalabortion. Though he concurs with FDA studies that no deaths, heartattacks, or strokes, associated with the drug, Dr. Hager expressedconcern that young girls would misuse the drug.8 For only thesecond time in 50 years, FDA administrators overruled its advisorypanel’s recommendation that the drug be approved forover-the-counter sale.9 An FDA spokesperson stated that theapplication was rejected for scientific, not moral or religiousreasons. Critics, however, pointed to a letter writing campaign bya group of conservative members of congress that encouraged the FDAto oppose the application. On the other side of the aisle, senatorswho support making Plan B more easily available have been delayedthe confirmation of the FDA Commissioner Lester Crawford.10 Tocontribute to the fury, the director of the FDA’s Office of Women’sHealth resigned in protest over the decision.11 Target Policy andResponse Provoked by outside players like Planned Parenthood,Target was forced to define and publicly express a clear policy.Target announced that pharmacists have the right to refuse to filla prescription if doing so would be counter to their moral orreligious convictions. Nonetheless, the company stated, pharmacistsmust also sign a “conscience policy” that requires them to helpcustomers get their medications in a timely manner by referringthem to another pharmacist on duty or to another pharmacy. Reactionto this policy was mixed. Planned Parenthood applauded Target’scommitment to ensuring that prescriptions be filled, but expressedconcern that refusals could cause delays that would interfere withqualified medical treatment and possibly make the medication lesseffective. This, critics argue, would be of particular concern inareas where there is no other pharmacy nearby. “Timeliness,” inother words, was left open to interpretation. In a panel interviewon National Public Radio, a target spokeswoman responded to aPlanned Parenthood spokeswoman: “Most Targets are in metropolitan,suburban or urban areas, so, you know, there’s very likely to beanother pharmacy very close by.”12 Target has also been pressed forclarification about how broadly applicable pharmacists’ right ofrefusal should be. While the corporation states that it is requiredby the 1964 Civil Rights Act to make “reasonable accommodations fortheir employees’ religious beliefs,” the corporate policyapplies only to the Plan B drug. Pharmacists are not allowed torefuse prescriptions for any other medications.13 If strongly heldmoral beliefs and made this issue complicated for target tonavigate, differences in state laws have made the problem almostintractable. In fact, state law typically determines the balancebetween pharmacists’ and consumers’ rights and some states takevery different approaches than others. Legislative directives aboutpharmacists’ rights in Missouri, for example, were in many waysopposite those in neighboring Illinois. State laws complicateTarget’s response and its competitors’ responses. Walgreen’s inIllinois The American Center for Law and Justice (ACLJ) iscurrently representing 4 pharmacists who were terminated at anIllinois Walgreen’s after failing to fill prescriptions for Plan B.Defending the “Healthcare Right of Conscience Act,” the ACLJ claimsthat the pharmacists have a right to refuse based on moral grounds.While this law does support the pharmacists’ actions, it alsostipulates that the pharmacy must ensure that prescriptions befilled in a timely manner through a referral.14 At first glance theMissouri and Illinois laws appear identical, but they differ intheir definitions of “timely manner” and of “referral.” InMissouri, the law allows a pharmacist to refer a customer to adifferent nearby pharmacy.15 In Illinois, the pharmacist must referthe customer to another professional within that pharmacy, unlessthe customer specifically requests a referral to a differentpharmacy. Furthermore, Illinois defines “timely” as about 45minutes, the average time it takes to fill a typical (notnecessarily emergency contraception) prescription. Missouri law, onthe other hand, doesn’t specify a maximum delay. A pharmacist mayrefuse to fill a prescription without regard to the delay it willcause the customer, and the pharmacy is not compelled to ensurethat the prescription is filled. In Illinois, the pharmacists’rights are protected only insofar as they do not exacerbate thetime constraint for the customer.16 Wal-Mart in MassachusettsHistorically, Wal-Mart has managed to skirt the emergencycontraception controversy by refusing to stock the drug. Increasedpublic attention to corporations’ policies on the matter, however,has left few companies unprovoked. On February 1st, 3 women filed alawsuit against Wal-Mart for not stocking Plan B in its pharmacies.Technically, all Massachusetts pharmacies are required by law tocarry all “commonly prescribed medicine” that the community needs.Wal-Mart’s policy was legally viable only if Plan B could beconsidered unnecessary or uncommonly prescribed. However, onFebruary 14th, the state addressed the legal technicality andrequired Wal-Mart to stock Plan B in all pharmacies. Wal-Martcomplied immediately and company officials say the retailer isconsidering stocking the drug nationwide, though there is noindication that the policy has changed yet.17 Current Situation Ina lawsuit unrelated to Rachel Pourchot’s case, Target is currentlybeing sued by a Missouri pharmacist, Heather Williams, under theFederal Equal Opportunity Employment Commission. Williams refusedto sign the company’s “conscience policy” and argues that herrights were violated when she was fired. A Chicago-basedanti-abortion group, Americans United for Life, claims that thetermination occurred because Planned Parenthood threatened aboycott of Target stores. Planned Parenthood has vehemently deniedany involvement in the matter and denies having planned orthreatened a boycott. As of January 26, 2006 Target had notreturned calls to the Associated Press.18 Target will continue toface public scrutiny as public expects the corporation to take aside in the debate over pharmacists’ right to refuse and theconsumers’ right to have a prescription filled without delay.Complicating matters further, the corporate strategy will have todiffer across state lines, which will likely create issues over howaccurately Target’s corporate values are portrayed in themedia.

Questions:

• Using what you have learned from the textbook, How likely isTarget to suffer a significant loss of revenue because of Plan B?What consumer group will be the most likely cause for revenueleakage?
• How should Target respond to Heather Williams’ Federalcomplaint?