Opinion: Over-the-counter birth control pills would be life-changing for millions
As we grapple with a post-Roe vs. Wade world, policymakers and regulatory experts have a critical responsibility to expand access to reproductive healthcare for all. That includes ensuring anyone who needs birth control can get it without facing barriers.
On May 9, the Food and Drug Administration is set to convene a meeting of experts to evaluate the first-ever application for an over-the-counter birth control pill in the U.S. The application is for a progestin-only pill, which doesn’t contain estrogen. The FDA meeting is a promising sign — and the closest we’ve been to seeing an oral contraceptive on the pharmacy shelf without the need for a doctor’s prescription.
The California Legislature must act immediately on two bills to reduce the cost barrier for women seeking contraception and abortion care.
From a medical perspective, this is a “no-brainer.†Birth control pills should be available without a prescription for people of all ages. It makes no sense for healthcare providers to hold people’s birth control hostage in the clinic, forcing patients to be seen in person before giving them a prescription for the contraceptive they need. It’s really time to free the pill.
While the FDA and its experts will have to carefully weigh the evidence, substantial research — including studies I have led — indicates that OTC birth control pills are safe and effective. Research suggests that people who have access to OTC birth control pills stay on them longer because it’s easier to get more when they run out. In a national survey, 39% of adults and 29% of teens said they would be likely to use this type of pill if it were available without a prescription. Importantly, adding the option of OTC access would not take away the option of seeing a clinician to answer any questions or to discuss the full range of contraceptive options.
That said, policymakers must still address two concerns to promote full reproductive equity.
The forces fighting against legal abortion have already shown their hand: Contraception is the next target.
The first is the cost. If the FDA approves this application for an OTC pill, but it is sold at an inaccessibly high price and is not covered by insurance, it will miss the mark. Right now, more than 19 million people need access to publicly funded contraception. Black, Indigenous and other people of color, as well as those working to make ends meet, face the greatest barriers to contraception. If they don’t benefit from the switch to over-the-counter sale of the pill, then this change won’t actually improve access for those who need it.
Second, without legislative protection, insurance companies could require people to get a prescription in order to cover an OTC birth control pill. Requiring a prescription negates the convenience of an OTC product and undermines any hope for improvement in access that comes with OTC approval.
The Affordability is Access Act, a bill proposed by Democratic lawmakers last year, would require insurance companies to cover the costs of an FDA-approved over-the-counter birth control without out-of-pocket costs. This law would be nothing short of life-changing for millions. However, with a majority in the House that opposes reproductive healthcare, the ability to ensure access to birth control lies with the states.
States don’t have to wait for Congress to act — they can take steps right now to ensure contraceptive equity. Right now, only about eight states require insurers to cover OTC birth control without needing a prescription, leaving a gap in access for millions. In California, coverage of OTC birth control methods was incorporated into SB 523, which was passed by the Legislature and signed by Gov. Gavin Newsom last year, and other states should follow suit. States such as Maine, Colorado, Michigan and Vermont have taken steps in recent years to protect reproductive health services, but still lack the policies needed to ensure coverage for OTC birth control. The attacks on birth control aren’t stopping, and it’s up to state legislators across the country to ensure contraceptive access is a reality for all.
People in over 100 countries have access to the birth control pill without a prescription, and 77% of women in the U.S. support making it available OTC. As the FDA continues its review of the evidence for over-the-counter use, we need to make sure this change in regulatory status has a meaningful impact in people’s day-to-day lives.
Daniel Grossman is a professor of obstetrics, gynecology and reproductive sciences at the UC San Francisco and director of Advancing New Standards in Reproductive Health.
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