When it comes to moving oral contraceptives over the counter (OTC), almost 50% of participants in the Contraceptive Technology Update Contraception Survey say they support such a move. Support for OTC access is growing; 62% of American women support the pill being available without a prescription.1
Moving the Pill to OTC status was spotlighted in 2014 when some opponents of the Affordable Care Act’s (ACA) contraceptive coverage guarantee promoted the idea that oral contraceptive pills should be available to adult women without a prescription. In July 2014, Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY) introduced the Preserving Religious Freedom and a Woman’s Access to Contraception Act, a bill calling for the Food and Drug Administration (FDA) to study such a move. With a new Congress set to convene, it is unclear whether Congressional conservatives will further address the over-the-counter issue. (To read more about the 2015 legislative forecast, see the CTU article “Family planning issues might be in this Congress’ crosshairs,” January 2015, p. 10.)
“Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women,” states a recent journal of health policy thought and research.2 “However, such a change is no substitute for public and private insurance coverage of contraceptives, let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it.”
Insurance coverage
It is extremely important that insurance cover all forms of contraception, including all formulations of OCs and all over-the-counter methods, including a future OTC pill, says Daniel Grossman , MD, vice president for research at Ibis Reproductive Health in Oakland, CA. “It is important to note that one formulation of OCs will move over the counter at a time, and a progestin-only pill (POP) is the most likely first candidate for a future OTC OC product,” notes Grossman. “This means that the vast majority of other pill formulations would remain available by prescription only.”
Ibis Reproductive Health coordinates the Oral Contraceptives (OCs) Over-the-Counter (OTC) Working Group, an informal coalition of reproductive health and rights organizations, nonprofit research and advocacy groups, university-based researchers, and clinicians who are looking at the risks and benefits of demedicalizing contraceptive care, with an eye toward improving access to OCs and potentially other hormonal contraceptive methods by making them available without a prescription.
Progestin-only pills have fewer contraindications and thus might have a better safety profile than combined oral contraceptives, which makes them a potential first candidate for OTC access. Because progestin-only pills do not contain estrogen, they carry a lower risk of estrogen-related complications, such as stroke, heart attack, or blood clots.
Anita Nelson, MD, professor in the Obstetrics and Gynecology Department at the David Geffen School of Medicine at the University of California in Los Angeles, supports bringing progestin-only pills over the counter. Nelson says such a move is more than a decade overdue. About 32% of 2014 CTU survey respondents say that, in some situations, they would be in favor of an OTC progestin-only pill.
Would women begin using a progestin-only pill if it were available? Results of a recent survey indicate women would begin using such a pill if it were available. However, results suggest that few women would pay more than $30 per pack of pills.3
Physician support for expanding access has grown in the last year. In 2014, the American Academy of Family Physicians of Leawood, KS, adopted a resolution supporting over-the-counter access to oral contraception without a prescription. In its resolution, the group states its support of insurance coverage of oral contraceptives regardless of prescription status in all insurance plans. Groups such as the American College of Obstetricians and Gynecologists (ACOG) and Planned Parenthood Federation of America also have come out in support of expanded access. (CTU reported on the ACOG committee opinion. See “Should the Pill go OTC? ACOG says ‘yes’ to move,” February 2013, p. 15.)
If a birth control pill does reach over-the-counter status, affordability is an issue. Uninsured women on average pay $370 for a full year’s supply of the Pill.2
Cost continues to be a barrier to accessing emergency contraception over the counter, notes Grossman. To make a future over-the-counter birth control pill accessible, it must be available at an accessible price and covered by insurance, ideally without a prescription, he states.
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Grossman D, Grindlay K, Li R, et al. Interest in over-the-counter access to oral contraceptives among women in the United States.Contraception 2013; 88(4):544-552.
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Sonfield A, Barot S. Birth control pills should be available over the counter, but that’s no substitute for contraceptive coverage.Health Affairs Blog 2014; accessed at http://bit.ly/1t5dllP.
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Grossman D, Fuentes L. Over-the-counter access to oral contraceptives as a reproductive healthcare strategy. Curr Opin Obstet Gynecol 2013; 25(6):500-505.
