Making the Pill Available Over the Counter Should Be Part of Broader Strategy to Enhance Contraceptive Access
The evidence strongly supports making oral contraceptive pills available without a prescription, but any effort to do so should complement—rather than replace—policies to reduce barriers to contraceptive use, argues a new analysis in the Guttmacher Policy Review. In particular, moving the pill to over-the-counter (OTC) status should be done alongside important safeguards, such as ensuring insurance coverage for OTC contraceptives and not imposing medically unnecessary age restrictions.
Reproductive health experts have long grappled with whether and how oral contraceptive pills could be responsibly switched to OTC status. The issue became politicized when some social conservative policymakers used it during the 2014 elections to deflect attention from their anti-birth control stances, such as opposition to the Affordable Care Act’s (ACA) contraceptive coverage guarantee.
"Despite the politicization of the issue, there is a strong evidence-based case in favor of moving oral contraceptives over the counter," says Sneha Barot, author of the new analysis. "Doing so certainly would reduce barriers to this popular method of birth control for some women, but it would clearly be insufficient as a stand-alone strategy to ensure contraceptive access."
Barot’s analysis discusses rival legislation on this issue introduced in the U.S. Congress, cautioning in particular that a bill backed by some social conservatives has serious flaws. The legislation would limit OTC access for the pill to adult women, which would impede access for minors and—by requiring photo ID—could ensnare even many adult women, especially those who may be undocumented.
The bill also assumes that OTC status will inevitably reduce costs and make insurance coverage unnecessary, even though the price for emergency contraception—the only hormonal contraceptive method available without a prescription—has remained high even after the switch to OTC. Moreover, OTC status for one form of birth control—at any cost—would be no substitute for the ACA’s policy requiring plans to cover the full range of methods without any out-of-pocket costs.
"Certainly, OTC status for oral contraceptives is one strategy to improving access, but it would not and could not fulfill the wide range of needs of all people, especially if cost and age barriers were attached to any product," says Barot. "If policymakers truly wish to expand contraceptive access, they need to take a comprehensive approach that works for people of all ages and incomes, and covers the full range of contraceptive methods, services and care."
Barot explains that the process for determining OTC status for the pill must be based on scientific and public health considerations that involve drug manufacturers and the Food and Drug Administration (FDA), not Congress. Further, there are dozens of formulations of birth control pills that are not interchangeable. Barot outlines that for each of them, drug makers would need to undergo the costly process of applying for a status switch. Even if this were done successfully for one or more formulations of the pill, it would likely only benefit a small proportion of current pill users.
Barot concludes that rather than latching onto OTC status for birth control pills, policymakers could show their commitment to advancing reproductive health through steps such as strengthening contraceptive coverage under the ACA, supporting safety-net family planning centers, increasing funding for the Title X family planning program and advocating for additional states to adopt the ACA’s Medicaid expansion.