The next time you’re at the drug store picking up Advil, tampons, or condoms, imagine what it would be like if you could grab your birth control pills off the shelf the same way – no questions asked or prescription required. No more marking your calendar to order refills, and no interacting with a provider just to get the go-ahead to take hormonal birth control in the first place.
In June this seemed like it could be reality sooner rather than later, thanks to a Twitter exchange between Representative Alexandria Ocasio-Cortez and Senator Ted Cruz in which the political opposites discovered they agreed that the pill should be OTC. And the issue is headed to the Senate, thanks to the “Allowing Greater Access to Safe and Effective Contraception Act,” which was introduced March 29th by Republican Senator Joni Ernst of Iowa and would make the pill available over the counter nationwide. If this happens, the U.S. would join the more than a hundred countries where this is the norm.
It Only Sounds Simple
Since it has bipartisan support in Congress and isn’t even up for debate in much of the world, making birth control available without a prescription should be a no-brainer, right?
If only it were so easy. For one thing, Cruz and Ocasio-Cortez support OTC BC for very different reasons — as the Washington Post explains, Cruz and some other Republicans don’t want insurance companies to have to pay for birth control (which they’re currently mandated to under the Affordable Care Act) and making it available without a prescription would shift the price to women, not their plans. Women are less enthusiastic about prescription-free pills when they realize that over the counter could also mean out of pocket, so Democratic Senator Patty Murray of Washington has introduced a bill that aims to secure insurance coverage for birth control in the event that it becomes available over the counter.
Efforts to make the pill available OTC aren’t new, and have been a long, slow, slog, stymied by regulatory hurdles and political roadblocks. For one thing, a Congressional bill can’t change the status of birth control pills on its own – it takes the Food and Drug Administration (FDA) to do that, in response to a petition from a drug company. That step, though, is also moving closer to reality, with two pharmaceutical companies, Cadence and French company HRA Pharma, both in the early “research” stages of the process. And the Ernst Senate bill aims to facilitate that process by directing the secretary of Health and Human Services to fast-track review of any oral contraceptive drugs once the FDA application has been made.
Some states have pushed ahead of the Federal government and made oral contraception available on the spot with a prescription issued by a pharmacist. The latest to do so was New Hampshire, which in July 2018 joined California, Colorado, Hawaii, Maryland, New Mexico, Oregon, Tennessee and Washington D.C. in passing such a state law.
This doesn’t necessarily mean, however, that in these states today you can walk into your local CVS or Duane Read and order up some pills. The laws require pharmacists to have special training and don’t require pharmacies to provide the service, so phase-in has been slow in many places.
Why OTC Contraception Makes Sense
From the American College of Obstetrics and Gynecology (ACOG) to Planned Parenthood, many of the most respected women’s health and advocacy organizations have come out in favor of the “free the pill” movement. Even the usually conservative American Medical Association voted this summer on a resolution to support OTC pills.
The “free the pill” movement makes sense to many given that more than 10.5 million American women are currently on an oral contraceptive, and that pills containing low-dose hormones are actually much safer than many of the other medications that stock pharmacy shelves. Simply put, wouldn’t it be great not to deal with the difficulties and delays many women face when trying to get a birth control pill prescription when they need one?
Why Some Have Concerns
That said, there are some legitimate reasons why talking with a doctor before starting to take birth control pills is a good idea. Hormonal birth control, especially combination pills containing both estrogen and progestin, pose risks for many women, such as those with high blood pressure or who experience migraines with aura.
There’s also concern about some of the less serious side effects that are relatively common when you start a new pill, such as acne and mood swings. Having a medical provider available to talk over these issues might help you weather them better. Lastly, some experts worry that without the need to consult a doctor or nurse practitioner about birth control, women might not seek help as readily for concerns about STIs and other reproductive health issues.
The Bottom Line
While it may still be some time before you can walk into a pharmacy and buy a pack of birth control pills without a consultation of any kind, the landscape looks to be changing fast. Meanwhile, telemedicine services like Nurx make it much easier to order birth control online, by connecting you with a licensed provider virtually for a prescription and sending the medication directly to your door.
About the Author
Melanie Haiken is an award-winning health, science and travel writer and founder of www.health-conscious-travel.com
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