Telecontraception Apps Can Reduce Some Barriers to Reproductive Care
Apps applauded by users
EXECUTIVE SUMMARY
Telecontraception apps are well received by users and appear to eliminate some barriers to contraception care, according to the results of a new study.
- App users reported they especially liked on-demand access to clinicians, with no long wait times.
- Users also gave positive reviews for the apps’ affordability and how these could help people facing insurance challenges.
- Some people described telecontraception apps as a lifesaver.
Telecontraception apps can expand access to reproductive health and contraception care for women, but more action is needed to eliminate barriers to access.1
Researchers studied online reviews from two telecontraception apps to gather data about app users and their experiences, including their motivation, says Jenna Nitkowski, PhD, post-doctoral research fellow at the Center for AIDS Intervention Research of the Medical College of Wisconsin in Milwaukee.
Nitkowski performed a qualitative analysis and found these major themes, common to use of both apps:
• Access and timeliness. Users liked on-demand access to clinicians so they did not have to make an appointment and wait for months.
“They can ask questions and get a lot of information about their options, and it’s related to clinician interactions,” Nitkowski says. “Other issues were related to cost and affordability.”
The cost structures for telecontraception apps vary, including whether they take insurance. The reviews on cost were mixed.
• Favorable view of telecontraception. “A lot of reviews mentioned these apps were a lifesaver for them if they were between jobs and didn’t have insurance and needed access to their medication,” Nitkowski says.
Users also talked about telecontraception as a game-changer. “A lot of users said this was a great thing for women to have. They appreciated it and thanked companies in reviews for doing this for women,” she says.
• Platform experience. Some portion of comments were related to the apps and not to telecontraception. Users sometimes complained of a bug in the system or problems uploading information.
Users who called the app a “lifesaver” discussed how they needed a birth control prescription and were unable to access a provider in a non-virtual environment.
“They needed access to birth control and were told, ‘We can book you in three months for an in-person visit to prescribe birth control,’” Nitkowski explains. “Based on my research in the field, there is no medical reason to have an in-person visit to prescribe birth control.”
All prescribers need to know is the person’s blood pressure. Telecontraception apps can prescribe birth control without an in-person visit. Patients self-report blood pressure readings from a previous doctor’s appointment or from a blood pressure machine in a pharmacy.
“There’s no medical or scientific reason why birth control pills couldn’t be prescribed through telemedicine,” Nitkowski adds. “A lot of times, there is gatekeeping, where someone says you need to come in to get a Pap smear.” But Pap smears are not necessary when the visit solely is for obtaining contraception.
The telecontraception apps charge a flat fee for the consultation. This could be covered by some insurance companies. But even if people pay for it out of pocket, the fee is nominal — about $10, Nitkowski notes.
Nitkowski started the study in 2020 and found that about 10 states allowed telecontraception apps at that time. By the time she published the study, telecontraception platforms were available in nearly all states.
The pandemic may have hastened adoption of telecontraception. Also, the apps were given cultural status. “During that time, a lot of media attention called it ‘the Uber for birth control,’ things like that,” Nitkowski says. “It started getting more mainstream headlines about how this could change healthcare.”
Telecontraception platforms include Nurx and Planned Parenthood Direct. They vary in cost, in features, and in who is using them. For example, Nurx saw its largest number of sign-ups in Texas — a state with the most contraceptive deserts. Also, nearly one in four women are without insurance — the highest percentage nationally.1,2
Nurx provides telemedicine access to physicians, nurse practitioners, physician assistants, nurses, and pharmacists, Nitkowski says. “Nurx is an online startup and does not take Medicaid, so the app is for people who can afford it and who have private insurance,” she adds. “They provide unlimited messaging with a provider. Any questions you have, or if you have a side effect, you can message them.”
When Nitkowski began her research, Nurx only offered birth control. Now, the service includes skin care, acne treatment, treatment of urinary tract infections, mental healthcare, and in-home testing for sexually transmitted infections. “They do now offer emergency contraception, but not medication abortion,” she adds.
Planned Parenthood Direct began as a pilot program in six states, and now is more widely available. The app is available in 42 states, and will soon be available in all states. The app website notes it offers birth control pills by mail with no visit fee and a cost of $15-$25 per pill pack, varying by state. The app also offers Ella emergency contraception at $80 per pill, which can be shipped overnight. All shipping is free, and people also can pick up some contraceptives — a birth control pill, patch, or ring — at pharmacies.3
The following are sample comments from app users:
- “I couldn’t find an appointment for birth control before when I’m supposed to put in a new ring. When I downloaded the app, I got my prescription in less than five [hours].”
- “I’ve had so many struggles finding the right pill for me, and this app got it right on the first try. The papers with all the [information] they send is so helpful and makes me feel so comfortable.”
- “I pay $15 a month without my insurance, but I don’t mind because they’ve made this so easy.”
- “These apps started before COVID, but now telehealth is a common thing — it’s grown exponentially,” Nitkowski says. “These apps hold a lot of potential to increase access to birth control for women.”
The apps provide information about birth control options and access to clinicians. Patients can obtain a birth control prescription quickly and answer their questions without leaving home.
“A lot of women expressed how this was a needed service and used the words ‘lifesaver,’ and ‘game-changer,’ so that’s huge,” Nitkowski says. “All women should be able to access what they need regardless of where they live, so this helps with contraceptive deserts. This allows women to access healthcare on their own time, and it’s convenient for them.”
As telecontraception apps expand and grow their client base, they also lead to more insurers and employers subsidizing their use because it could reduce costs. “We can save healthcare costs by doing some services virtually, and this may be one of those, too,” Nitkowski says.
REFERENCES
- Nitkowski J. Qualitative analysis of user reviews from Nurx and Planned Parenthood Direct: What user experiences reveal about telecontraception apps. Sex Health 2022;19:417-426.
- Nitkowski J. State-level conditions and telecontraception platform availability. Health Policy Technol 2023;12:100722.
- Planned Parenthood Direct. 2023.
Telecontraception apps are well received by users and appear to eliminate some barriers to contraception care, according to the results of a new study. More action is needed to eliminate barriers to access.
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