Getting the pill over-the-counter is only part of removing barriers to contraception

Making oral contraceptive pills available without a prescription should complement, not replace policies to reduce barriers to contraceptive use, according to a new analysis by the Guttmacher Institute. Moving the pill to over-the-counter (OTC) status should be done to enhance women’s access to the full range of contraceptive methods, instead of taking its place. It is important that, while the barrier of the counter is removed, other safeguards remain in place to protect women’s access to contraception, such as ensuring insurance coverage for OTC contraceptives and not imposing medically unnecessary age restrictions.

OTC rationale

Access to birth control has long been touted as the best way to prevent unintended pregnancies. Lifting the prescription requirement for birth control pills could lower barriers to access the pill and achieve the desired results. The Guttmacher Institute noted in their analysis that U.S. women rely on the pill more than any other method. In 2012, 26 percent of contraceptive users relied on the pill; the next most commonly used methods were female sterilization (25 percent) and male condoms (15 percent). The Institute believes that “increasing access to the pill by making it available OTC could improve contraceptive use and, in turn, lower unintended pregnancy rates, especially among women who are uninsured and those who lack the time, would need to arrange for child care, or otherwise would find it difficult to visit a health care provider to obtain a prescription.”

Issues

For a formulation of a birth control pill to switch to OTC status, a pharmaceutical company would need to initiate an often lengthy and expensive process that entails research (including studies of label comprehension and consumer actual use) and review by the FDA, which can be a huge deterrent. Once put in the hands of the FDA, the agency may decide to impose an age restriction on an OTC product, which would limit access for young women. These young women, the Guttmacher Institute notes, face a greater risk of unintended pregnancy and more barriers to accessing contraceptives than older women—and therefore have the most to gain from an OTC status switch. It is important they not be left out. Additionally, imposing an age requirement would then require a means of identification. This would be a disadvantage not only for adolescent and young women without government-issued photo IDs, but for immigrants as well, particularly those who are undocumented.

Packaging is also a consideration. Oregon and the District of Columbia this year enacted legislation requiring birth control pills to be packaged in one year supplies.

Comprehensive approach

The Guttmacher Institute advised that taking a comprehensive approach is best, and if policymakers truly wish to expand contraceptive access, they need find one that works for people of all ages and incomes, and covers the full range of contraceptive methods, services and care. It believes that OTC status for oral contraceptives is but one strategy to improving access that is unable to fulfill the wide range of needs of all people, especially if cost and age barriers were attached to any product.

Although the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) goes a long way towards providing contraceptive coverage, it also has limitations. Some of these could be addressed by covering more women and dropping the need to obtain a prescription for OTC coverage. According to the Guttmacher Institute, what the ACA began in terms of contraception coverage policy should be only strengthened by providing OTC birth control pills. An OTC designation for birth control should not replace the contraception coverage requirements if public policy is truly meant to provide women with coverage options that are best for them.