Ulipristal acetate emergency contraception access and dispensing in Alberta, Canada, from 2015-2023

To describe temporal and geographic patterns of ulipristal acetate (UPA) dispensing in Alberta, Canada, following Health Canada approval, and to assess whether UPA access aligns with population demand.

Repeated cross-sectional, population-level analysis of all Alberta residents aged 15 to 49 years between September 1, 2015, and June 30, 2023. UPA dispensing was captured via the Pharmaceutical Information Network. The primary outcome was the annual, population-standardized rate of UPA dispensing per 10,000 females. Secondary outcomes included travel time and distance to pharmacies, number of prescribers, and number and proportion of pharmacies dispensing UPA. Temporal trends were analyzed using ordinal least squares or median regression; spatial patterns were evaluated via subzone-level mapping of UPA demand and supply.

A total of 1990 UPA prescriptions were dispensed during the study period. First dispensation occurred 86 days post approval. UPA utilization increased steadily over time at a rate of 0.38 additional UPA uses per 10,000 females annually. The number of prescribers and the proportion of pharmacies dispensing UPA also increased over the interval. Median travel time and distance remained stable, with extended travel (more than 2 hours) only in remote regions. Geospatial analysis demonstrated general alignment between patient demand and pharmacy supply, including in rural regions, suggesting equitable geographic access.

UPA access in Alberta has steadily increased, with improving availability across the province and evidence that urban and rural populations are being equally served. Despite this progress, uptake of UPA post approval was slower than expected for a newly marketed prescription drug, highlighting potential barriers related to awareness, adoption patterns, and coverage.

Ulipristal acetate use in Alberta, Canada, steadily increased since approval, with equitable rural and urban access. First-year uptake appeared to have a lag compared to other new medications, suggesting adoption barriers. Clinician awareness, patient education, and policy support remain essential to ensure equitable access to this highly effective emergency contraception.