Birth control pills are safe and effective, but there are currently too many barriers to access them. Here's how moving pills over the counter can help:
• Moving pills 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 pills over the counter reduces 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, birth control pills have other benefits besides preventing pregnancy. Depending on the pill you choose, it can reduce pain and heavy bleeding with periods, help prevent acne and anemia, reduce 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.
A pharmaceutical company must submit an Rx-to-OTC switch application to the US Food and Drug Administration (FDA) requesting to switch a prescription-only medication like birth control pills to be available OTC. Learn more about the FDA application and review process as well as the key moments ahead.
There are many formulations of birth control pills. Through the FDA process, an application would need to be submitted for each formulation in order for it to be considered for OTC use. While your specific pill brand may not move over the counter, no unique formulation has been shown to be more effective at preventing pregnancy than any other.
Some people worry about whether moving birth control pills 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.
• Both progestin-only pills (POPs), which contain estrogen, and combined oral contraceptives (COCs), which contain both estrogen and progestin, are safe and effective for most women. However, because POPs don’t contain estrogen, they may be safer for people with certain health conditions. Studies show that women are able to use a simple checklist to accurately identify health conditions that might make taking birth control pills less safe or less effective, and consult with a pharmacist or another health care provider if they have any questions.
• The pill is 99% effective if taken exactly as directed (91% with typical use).
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.
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.
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.
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: https://freethepill.org/online-pill-prescribing-resources