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Why are nonprescription birth control pills so important? How much will they cost? What do anti-abortion groups think about the decision?
The US Food and Drug Administration (FDA) recently approved a nonprescription birth control pill for the first time. This is a huge deal, especially in a post-Roe v. Wade country where abortion access is restricted in many states.
Continue reading to learn about this OTC birth control pill, the impact it will have, and how much it might cost.
OTC Birth Control Pills Have Been a Long Time Coming
The FDA’s approval clears the way for millions of Americans to buy Opill—a daily oral contraceptive—over the counter at drugstores, grocery stores, convenience stores, and online beginning in early 2024. The regulatory change comes six decades after daily birth control pills were first introduced in the US and five after norgestrel, the form of progestin used in Opill, was first approved for prescription use in 1973.
Opill is a low-dose birth control pill sometimes called a “minipill” because it contains only progestin (rather than both progestin and estrogen). It’s slightly less effective at preventing ovulation than estrogen-containing pills. Nonetheless, experts note that Opill is more effective than other nonprescription contraceptives such as condoms and spermicides. The FDA approved Opill as a nonprescription birth control pill after studies demonstrated that consumers can use it safely and effectively without consulting a physician.
Why Does a Nonprescription Pill Matter?
Offering Opill without a prescription is expected to reduce access barriers to a safe and highly effective method of preventing pregnancy for millions of Americans. Many Americans find it difficult to regularly see a doctor or to afford the transportation, childcare, and unpaid time off work needed to keep an appointment. Increasing access to oral contraceptives will benefit public health: Almost half of the 6.1 million pregnancies in the US each year are unintended, and such pregnancies are associated with an increased risk of negative outcomes for the pregnant person and the baby.
How Accessible Will Opill Be?
The extent to which the change actually makes Opill more accessible likely comes down to its affordability. The cost of the pill will be decided by its manufacturer Perrigo, which says it’s committed to making the pill “accessible and affordable to women and people of all ages.” But “affordable” is subjective: A survey found that only 1 in 6 respondents were willing and able to pay more than $20 a month for the pill, while 34% said they could pay $11 to $20 a month and 39% said they could pay $1 to $10 per month.
It may be particularly important for Opill to be affordable without health insurance. Advocates have called for insurers to cover over-the-counter contraception without out-of-pocket costs, but the Affordable Care Act (ACA) requires insurers to fully cover birth control only with a prescription. To be reimbursed for the pill, many people might still need to obtain a prescription. Currently, more than half of US states allow pharmacists to prescribe hormonal contraceptives, which can help bridge gaps in access.
The out-of-pocket cost of Opill will be important not only for people who don’t have health insurance but also for those who feel uncomfortable or unsafe using their health insurance to purchase birth control.
What’s the State of Americans’ Reproductive Health?
The push for nonprescription status for oral contraceptives has taken on new urgency as access to reproductive health care shifts, and a growing maternal mortality crisis unfolds. Improving contraceptive access represents a step toward health equity, where a person’s race, ethnicity, gender, income, sexual orientation, immigration status, and neighborhood don’t disadvantage them from accessing health care. It’s also key to achieving reproductive autonomy, where individuals have the power to make and act on decisions about reproduction.
The accessibility of contraceptives is especially important for people living in states with abortion restrictions enacted since the US Supreme Court overturned Roe v. Wade last June. In the year that’s elapsed, 14 states have banned most abortions, and a 15th, Georgia, has banned abortion at six weeks, before many people know they’re pregnant. Experts say that these laws disproportionately harm people of color, who are three times more likely to die in childbirth than white Americans.
What Comes Next for Reproductive Health Care Access?
Many anti-abortion groups have remained silent on the FDA’s approval of Opill for nonprescription use. Opposition to the expansion of contraceptive access comes primarily from Students for Life and groups affiliated with the Catholic Church, which contends that some forms of contraception “cause early abortions” by preventing a fertilized egg from implanting in the uterus.
Following the end of Roe v. Wade, experts predicted that states might try to restrict access to contraceptives, though polls show bipartisan support for continued access. Advocates have noted that some Republicans have adopted a strategy of blurring the lines between medications that prevent pregnancy and medications that end pregnancy. They’ve done this by not only conflating contraception with abortion, but also by claiming that birth control endangers women’s health, both of which could affect attitudes toward potential future restrictions.
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