As Opill, the first over-the-counter (OTC) oral birth control pill to be approved by the Food and Drug Administration (FDA), makes its way to grocery stores and pharmacies across the country, its usefulness remains a question mark for many young people.
“I do think $19.99 a month is steep for young people, many young people,” says Sriha Srinivasan, a youth advocate with Free the Pill Youth Council and Advocates for Youth in Los Angeles. Srinivasan has testified before an advisory committee of the FDA about the need of having an OTC oral contraceptive.
In states where minimum wage is higher than the national $7.75 per hour, young people might feel less of the strain of the pill’s monthly cost. But for many young people, it is just too much money out of pocket, she says.
“I was excited because I thought Opill had a cost assistance program, and I signed up for it,” Srinivasan says. “But the consensus among my friends and myself is that it’s almost impossible to qualify for cost assistance.”
HRA Pharma has not done enough work to fulfill the goal of ensuring the contraceptive has equitable access for all who need it, she adds.
Srinivasan quickly found out that she did not qualify for cost assistance, despite being young and in need of help.
“To be eligible for Opill’s cost assistance program, you cannot be covered by any commercial or government insurance, including Medicaid,” she says. “You have to be at 200% of the federal poverty level (FPL) and reside in the United States or its territories.”
The part that is most problematic is the 200% FPL cap and the public insurance disqualifier.
“Two hundred percent ignores what poverty looks like in different parts of the country,” Srinivasan says. “The poverty line in California where I grew up is way different than in Tennessee. You can make six figures here and still have trouble affording rent and taking care of a family,” she says.
Using the same FPL cutoff for all Americans is not equitable, she says.
“I work in Los Angeles, and many may be living in poverty but may not be below the federal poverty level because it’s California,” she adds.
“You’re leaving out people from different parts of the country and cutting down the number who would be qualified by a lot,” Srinivasan says.
Disqualifying people who have some kind of insurance also leads to access inequity. For instance, college students often are required to have some kind of health insurance. But simply having insurance did not guarantee they had access to the contraceptive of their choice. Plus, any student who still relies on parental financial support could have their confidentiality jeopardized by having to obtain contraception through their parent’s insurance policy.
“There are many reasons why someone would like to use an over-the-counter birth control option, and HRA Pharma is aware of this,” Srinivasan says. “I was a student at UCLA, and while I was there, you had to be on some kind of insurance. You could not be an enrolled student and not have insurance.”
Srinivasan collected testimonials from students about Opill and found that many of them were struggling to access birth control — even with insurance.
Since insurance companies are not yet required to cover Opill, that makes it difficult for these students to obtain the OTC contraceptive, she says.
“This is even though there are students who would greatly benefit from the cost assistance program and who will struggle with the $20 cost,” she adds. “I’m greatly disappointed that many young people will not qualify for this.”
The whole point of having an OTC contraceptive is to reduce people’s barriers to contraceptive access. The fact that the cost assistance program has so many barriers just adds to the problem.
For high school students, the barriers may be insurmountable. They would still be on their parents’ insurance, which would automatically disqualify them from cost assistance.
Also, high school students may not even know the cost assistance program exists.
“High school students are just finding out that Opill exists, and finding out about the cost assistance program is another layer to that,” Srinivasan says.
Contraception advocates want the pharmaceutical company to make Opill more accessible through a more realistic cost assistance program, she says.
“We want them to modify their eligibility criteria to be equitable for all and to work with community organizations to get coupon codes out there to make it more equitable, instead of having a single cost assistance program,” Srinivasan says.
New York’s change to provide any contraceptive at no cost to people who need it is a good step in the right direction, she notes.
“Anything that improves contraceptive equity and access is amazing,” she adds. “I’m strongly of the opinion that young people are able to make their own decisions about their body autonomy, and I love it when states create these new pieces of legislation because they become blueprints for other states.”
Opill is a great contraception, and Srinivasan uses it. “I had one of my closest childhood friends hunt around pharmacies with me when Opill was being shipped out, and we bought the first bottles together,” she recalls. “She’s been taking it, and I’ve been taking it, and it’s kind of cute. We texted each other after the first few days — ‘Did you take your pill?’”
The pill has not had any unexpected side effects, and nothing has been troublesome, she adds.
Srinivasan works with high school students and educates them about Opill’s existence.
“There’s definitely excitement that this is an option that’s out there,” she says. “I have my own TikTok platform, and I feel a lot of excitement and gratitude that it’s out there.”
This is an option that people in more than 100 countries have had for a long time — an OTC contraceptive — but it is exciting that Americans now have this option as well, she adds.
When the FDA approved Opill, Srinivasan cried and began posting about the pill to her 190,000 followers on TikTok.
“I posted about buying Opill, and I showed myself taking Opill because I saw some fear online,” she says. “It’s a normal birth control pack where you can see all the instructions, and there’s a health line to call.”
Robert Hatcher, MD, MPH, Founding Author of Contraceptive Technology and Professor Emeritus of Gynecology and Obstetrics, Emory University School of Medicine in Atlanta, commented that finally there is an effective hormonal contraceptive available for women without a prescription. This has been sought for decades, he says.
As Opill, the first over-the-counter (OTC) oral birth control pill to be approved by the Food and Drug Administration (FDA), makes its way to grocery stores and pharmacies across the country, its usefulness remains a question mark for many young people.
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