Over-the-Counter (OTC)
Combined Oral Contraceptives (COC)
Advancement Subgroup
The Free the Pill Coalition Over-the-Counter (OTC) Combined Oral Contraceptives (COC) Advancement Subgroup was established in March 2025 and is convened to explore the potential opportunities and implications of an OTC COC. The subgroup shares insights, discusses research and develops recommendations to help inform the strategy for bringing COCs OTC in the United States. Further, the subgroup works collectively to ensure that future OTC COCs will be equitably accessible to all people and communities, especially those who face barriers to contraceptive access due to systemic inequities and would benefit most from OTC access.
This subgroup meets every other month to strategize ways to expand awareness, research, advocacy and education efforts around around COCs, and ensure equitable access to futures OTC COCs. Subgroup members have identified the following priorities for their work:
Developing materials to uplift evidence-based information about COCs, including what they are, how they can be used to prevent pregnancy, their benefits and risks, as well as the systemic barriers that hinder equitable access in the United States
Effectively addressing birth control user’s questions and potential concerns about COCs with evidence-based resources and population data
Combatting myths and disinformation about COCs and other forms of hormonal birth control, particularly medically inaccurate information that is amplified in both social media and mainstream media
Analyzing the Nonprescription Drug Product with an Additional Condition for Nonprescription Use (ACNU) rule and other federal policies to understand its impact on OTC birth control
Informing upcoming research and leveraging existing evidence on COCs to inform work to bring the first COC over the counter in the United States
Sharing work with Free the Pill coalition members and allied groups to support others in uplifting evidence-based information about COCs
The OTC COC Advancement Subgroup is open to Free the Pill coalition members who are signed on to our statement of purpose. If you are interested in getting involved in our work, please contact us.
Resources
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What’s the difference between combined oral contraceptives (COCs) and progestin-only birth control pills (POPs)?
Combined oral contraceptives (COCs) and progestin-only pills (POPs) are the two types of daily birth control pills that people can take to prevent pregnancy. While they have a lot in common, there are a few differences that people might want to be aware of as they decide which birth control method works best for them.
Spoiler alert—both types of daily birth control pills are safe and effective in preventing pregnancy!
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Research roundup: The evidence for bringing combined oral contraceptives over the counter
The first daily birth control pill approved by the US Food and Drug Administration (FDA) for OTC use was Opill, which is a progestin-only formulation. Cadence OTC, a pharmaceutical company that specializes in OTC sexual and reproductive health products, is currently working on their application to the FDA for an OTC COC.
Birth control pills are one of the most researched medications in existence, with hundreds of studies conducted all around the world for more than 60 years! The body of existing data demonstrates that these medications are suitable for OTC use and access.
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Role play: How would someone know if a COC was right for them?
In 2008, the first paper from the Border Contraceptive Access Study was published. This research examined how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives (COCs) using a medical checklist.
The TLDR? Self-screening for contraindications to oral contraceptives using a medical checklist is accurate, especially for younger women with a low prevalence of contraindications.