The rollout of the nation’s first over-the-counter (OTC) birth control pill, Opill, is a major step toward improving contraception access across the United States. But some obstacles remain, including cost and access for minors in places hostile to reproductive autonomy.
“We’re thrilled to hear they announced that Opill is launched and on its way to retailers,” says Victoria Nichols, MPH, project director of the Free the Pill Project at Ibis Reproductive Health in Oakland, CA. “This is a huge, historic moment. We celebrate Opill’s launch and availability without a prescription. A movement coalition has worked for two decades to get over-the-counter birth control in the United States.”
There are a few remaining barriers to accessing the OTC contraceptive, including cost. Nichols says the suggested retail price is $19.99 for a month’s supply, which might be too high for youth and others with low income.
“At $19.99, many people will not be able to afford the pill and benefit from this advance,” Nichols explains. “There’s still work to do to make sure Opill is accessible.”
A modeling study estimated that for Opill to be used by 12.5 million adults, ages 18 to 44 years, it would need to be available at no cost. For a $15 out-of-pocket cost, 7.1 million adults would use it. For teens, 760,000 would use Opill at no cost, but the number of predicted users drops at any out-of-pocket cost.1
In February, Walgreens and CVS announced that they would stock Opill nationwide. Other major companies planning to sell the hormonal contraceptive include Amazon, Target, Walmart, and Instacart, according to opill.com. The manufacturer also offers direct sales with free shipping and discreet packaging of Opill in three-month supplies for $49.99 and six-month packs for $89.99.
“Due to inequities, any cost of birth control pills can and will be too high for some, so there’s more work to do,” Nichols says. “The company has a cost assistance program, and we’re looking for how they can support people.”
For some people, insurance will cover the purchase, as mandated by the Affordable Care Act. But one drawback is that some insurers will pay only for prescription contraceptives. “This is an unnecessary barrier to access, and we’re working to make sure OTC birth control pills are fully covered by insurance without a prescription and without cost-sharing,” Nichols says. “We’re advocating for the Biden administration to make clear that health insurance plans must cover Opill without cost-sharing and without a prescription.”
Another barrier involves access to the OTC contraceptive for minors. The norgestrel birth control pill was approved on July 13, 2023, by the Food and Drug Administration (FDA) for nonprescription use to prevent pregnancy. It was first approved for prescription use in 1973. The FDA’s OTC approval means that retailers should not ask about the age of people purchasing the medication, and it should be readily stocked on the shelf. But studies of how easily youth can access OTC emergency contraception suggest this does not work as well as it should.2
Individual pharmacies may treat customers who are minors differently. Some pharmacies store OTC emergency contraception in a locked cabinet or ask for identification and parental consent before distributing it to minors.1 (For more information, see the related story in the November 2023 issue of Contraceptive Technology Update.)
Plus, a federal appeals court ruling says a Texas father has the authority to consent to his teenage daughter’s use of birth control under the federal Title X program. This means that family planning clinics in Texas must seek parental consent before distributing any contraception to minors, despite federal rules that allow Title X programs to provide contraception to all people, regardless of age. The March 12 court decision answered a lawsuit filed by Alexander R. Deanda, saying he should have the right to consent to his daughter receiving contraception at Title X clinics because Texas law requires parental consent for contraception. The United States Court of Appeals for the Fifth Circuit decided that despite the federal Title X program’s history since 1970 of universally distributing contraceptives to adolescents without parental consent, “Title X does not pre-empt Texas’s law.”3
The Texas law requiring parental consent likely would apply to OTC contraceptives, including Opill, but the impact was unclear in the days following the Fifth Circuit ruling.
“There is no medical reason for young people to not have access to birth control pills. Over-the-counter birth control pills, without age restriction, expands access to young people at a time when everyone should be able to get birth control pills if they want them,” Nichols says.
There are other ways to expand Opill access to young people, and nonprofit organizations may help with these efforts. For example, there could be an effort to expand vending machine access to Opill at college campuses and in places that do not have local pharmacies. This method is already happening with emergency contraception and could be coupled with Opill.
“We look forward to looking for ways to use vending machines to expand access,” Nichols says. “There is a lot we could learn from when emergency contraception was rolled out and how vending machines have been used to expand access and to [offer] discounted prices.”
Robert A. Hatcher, MD, MPH, chairman of the CTU editorial board, says, “The availability of an oral contraceptive without a prescription is a remarkable step ahead. $19.99 is too high a price, but it pales in comparison to the cost of pregnancy where abortion is not available and a woman must pay well over $1,000 in many states to travel to a state to obtain a safe first-trimester abortion.”
REFERENCES
- Wollum A, Trussell J, Grossman D, Grindlay K. Modeling the impacts of price on an over-the-counter progestin-only pill on use and unintended pregnancy among U.S. women. Womens Health Issues 2020;30:153-160.
- Ashcraft AM, Farjo S, Ponte CD, Murray PJ. The impact of caller characteristics on levonorgestrel emergency contraception access in West Virginia community pharmacies. Sex Reprod Healthc 2022;33:100765.
- Alexander R. Deanda v. Xavier Becerra. United States Court of Appeals for the Fifth Circuit. March 12, 2024. https://s3.documentcloud.org/d...
The rollout of the nation’s first over-the-counter birth control pill, Opill, is a major step toward improving contraception access across the United States. But some obstacles remain, including cost and access for minors in places hostile to reproductive autonomy.
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