Questions

  • Q:Is the pill I take going to move over the counter?
    A:

    There are many types (i.e., formulations) of the birth control pill. The most likely scenario is that one formulation would move over the counter at a time. It might not be your specific pill brand that moves over the counter. However, no brand of pill has been shown to be more effective at preventing pregnancy than any other.

    It is likely that the first pill to be made available over the counter in the US would be a progestin-only pill. Sometimes called the “mini-pill,” progestin-only pills do not have any estrogen. Like combination pills, which have both estrogen and progestin hormones, these pills are highly effective at preventing unplanned pregnancies. Both kinds of pills are 91% effective with typical use, meaning that they are usually, but not always, used exactly as directed. They are 99% effective when used exactly as directed. Progestin-only pills have almost no negative health implications when compared to combined oral contraceptive pills because they don’t have estrogen. Although all pills are very safe, most of the medical problems that can occur with the pill are from the estrogen in combined oral contraceptive pills. For example, combined oral contraceptive pills are risky for women aged 35 or older who smoke (they have a higher chance of blood clots), but progestin-only pills are okay for them.

    For more information on how the pill would move over the counter, check out the question, "How would a pill move over the counter in the US?"

  • Q:Why move a pill over the counter?
    A:

    There are lots of reasons to move a birth control pill over the counter. Unplanned pregnancy is a big issue in the United States –about half of all pregnancies are unwanted or mistimed. Here’s how moving a pill over the counter can help:

    • Moving a pill over the counter could make it easier to start using the pill and keep using it longer.

    • It’s not always easy to find time for a doctor’s appointment. Moving a pill over the counter reduce gaps in birth control use since there wouldn’t be a need to schedule a medical visit to get or refill a prescription.

    • A doctor's visit can be expensive. Under the health care law (the Affordable Care Act, or "Obamacare"), insurance covers preventive health visits with no cost-sharing (i.e. a co-pay). But not everyone has insurance, and there are also other costs related to an appointment, like for travel and child care. In a national survey of women, 1 in 5 said the cost of a medical appointment made it hard to get prescription birth control.

    • Plus, the pill has other benefits besides preventing pregnancy. It reduces pain and heavy bleeding with periods, helps prevent acne and anemia, reduces the risk of certain cancers, and more.

    • A study in the medical journal The Lancet showed that over the last 50 years the pill has prevented 200,000 cases of ovarian cancer and 100,000 deaths from the disease.

    • Have you ever run out of pills on the weekend or forgot to bring them on a trip? Wouldn't it be nice to pick up a pack of pills as easily as getting toothpaste or aspirin?

    Something with so many health benefits should be easy to get.

  • Q:Would an over-the-counter pill be safe and effective?
    A:

    Some people worry about whether moving the pill over the counter is a safe idea, but there are many reasons to believe an over-the-counter pill would be both safe and effective.

    •The potential for misuse or abuse is low—you can’t overdose on the pill.

    •People can decide on their own whether they need birth control.

    •The directions for taking the pill are simple—you just take one every day.

    •Pap smears or screening for sexually transmitted infections (STIs) are not medically required before prescribing the pill. Moreover, research shows that women still see their health care provider whether or not they are using a prescription contraceptive method. A research study on the US-Mexico border found that most US-resident women who obtain pills over the counter in Mexico also obtain Pap smears (91%) and STI testing (72%), as well as other preventive screening such as pelvic and breast examinations.

    •The pill is only effective as long as you keep taking it. A research study in Texas found that women who got their birth control pills over the counter in Mexico were more likely to stay on the pill longer compared to women who got their pills by prescription at a clinic.

    •The pill is safe for most women, and studies show that women are able to use simple checklists to accurately identify health conditions that might make using combined oral contraceptive pills unsafe, and that they are even more accurate with progestin-only pills.

    •It is likely that the first pill to be made available over the counter in the US would be a progestin-only pill. Progestin-only pills are even safer than combined oral contraceptive pills because they don’t have estrogen. Although all pills are very safe, most of the medical problems that can occur with the pill are from the estrogen in combined oral contraceptive pills. For example, combined oral contraceptive pills are risky for women aged 35 or older who smoke (they have a higher chance of blood clots), but progestin-only pills are okay for them.

    •The pill is more than 99% effective if taken exactly as directed (91% with typical use). It’s possible that taking your pill at the exact same time every day may be more important for progestin-only pills than for combined oral contraceptive pills, but there isn’t enough research yet to say for sure.

  • Q:What do women think about the pill being available over the counter?
    A:

    Research shows that US women from a range of racial and ethnic backgrounds and income groups are interested in obtaining the pill over the counter. In a national survey from 2011, 62% of US women at risk of unintended pregnancy were strongly or somewhat in favor of the pill being available over the counter, and 37% were likely to use the pill if it were available over the counter. In addition, 28% of women using no method and 33% of those using a less effective method, such as condoms used alone, said they would be likely to start using an over-the-counter pill. This suggests more women might start using the pill if they could get it over the counter.

  • Q:What do doctors think about the pill being available over the counter?
    A:

    The leading organization for US women’s health physicians, the American College of Obstetricians and Gynecologists (ACOG), reviewed much of the published evidence documenting the safety and effectiveness of over-the-counter access to the pill, and after weighing the risks and benefits, concluded that it should be available over the counter in the US. In addition, the American Academy of Family Physicians (AAFP) supports over-the-counter access to oral contraception without a prescription. The American Medical Association has also recommended that manufacturers of oral contraceptives submit the required application and supporting evidence to the US Food and Drug Administration for consideration for a switch from prescription to over-the-counter status.

  • Q:How would a pill move over the counter in the US?
    A:

    Over-the-counter access to the pill might sound revolutionary in the US, but it is already available without a prescription in over 100 countries. For a pill to go over the counter in the United States, a drug company will have to submit an application to the US Food and Drug Administration (FDA). It will probably take 3-4 years from the time a drug company begins an application process until a successful pill is available on the shelf. At this time no company has submitted an application.

    There are many types (i.e., formulations) of the birth control pill. The most likely scenario is that one formulation would move over the counter at a time. It might not be your specific pill brand that moves over the counter. However, no brand of pill has been shown to be more effective at preventing pregnancy than any other.

    If you'd like to learn more about the process for a pill to move OTC, click here.

  • Q:Will insurance cover an over-the-counter pill?
    A:

    Under the health care law (the Affordable Care Act, or "Obamacare"), most private insurance companies have to cover all types of FDA-approved birth control for women without any cost-sharing (a co-pay, for example). This includes OTC methods used by women (so not male condoms, unfortunately)—though only if they are prescribed by a health care provider. In other words, if you wanted your insurance to pay for an over-the-counter pill, you would probably need to get a prescription for it.

    For emergency contraception (EC), which is already available over the counter, some state Medicaid programs don’t require a prescription to have it covered, but most of them do.

    We want insurance to cover an over-the-counter birth control pill without having to get a prescription. We hope more insurance companies stop requiring prescriptions for OTC birth control in order to cover it. But leaving insurance coverage aside, an OTC pill could still be a great option for anyone who likes the convenience of getting the pill right off the drugstore shelf, and for people who don’t have insurance or whose employers don’t cover contraception.

  • Q:So what can I do?
    A:

    Make your voice heard—write a blog post, op-ed, or piece in your organization's newsletter or campus newspaper expressing your opinions about this issue. You can also fill out this survey to share your views. And 'Like' us on Facebook to keep up to date on the latest developments—find us here, and spread the word!

  • Q:What is the difference between over-the-counter and pharmacy access?
  • Q:Where can I get a prescription for the pill online?
    A:

    Check out our list of companies in the US and globally that issue prescriptions for the pill online, without requiring an in-person doctor visit: http://freethepill.org/online-pill-prescribing-resources

Do you have any further questions you’d like to ask? Drop us a line, send us a note. Give us your feedback. We want to hear from you.

Contact