On over-the-counter birth control

There’s a great blog post over at Health Affairs on why birth control pills should be available over the counter—and why that should be viewed a complement—not a substitute—for contraceptive coverage policies currently in place.

A few paragraphs I wanted to highlight:

Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women. However, such a change is no substitute for public and private insurance coverage of contraceptives — let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it. […]

Contrary to what some policymakers and commenters have claimed, giving the pill OTC status would not be an effective substitute for the ACA policy. First, it would do nothing to help women access any contraceptive method other than the pill. This matters, since most women use four or more different contraceptive methods over their lifetime to meet their changing needs. If only the pill were available OTC and contraceptives were no longer covered by insurance, women would face significant new barriers in choosing the method that best suited their needs. Cost is a particularly steep barrier for highly effective methods like the IUD or implant that not only have high upfront expenses, but also require a trained provider for insertion and therefore are not candidates for OTC status. […]

Just as birth control methods are not “one size fits all” at any point in a woman’s life, let alone for all of her reproductive years, neither is there a one-size-fits-all policy solution to enhance access to the full range of methods, information, and services for women of all ages and income levels, regardless of where they obtain their care. A wide range of approaches is necessary to meaningfully respond to women’s family planning needs in a comprehensive way.

The notion of having a drug available both over the counter (at market price) and under prescription (without a copay) isn’t crazy. That status already exists for emergency contraceptives like Plan B and Ella. Aspirin also enjoys this dual status, for people over 45 who use it therapeutically (if prescribed, there is no copay).

There’s another important point that the authors make: it’s not the place of politicians or policy-makers to move contraceptives over the counter.

Generally speaking, manufacturers will need take initiative to move birth control over the counter. There’s not a magical switch we can flip—it’s a lengthy and expensive process, one that needs to be done independently for different pills. “Because formulations of the pill are not medically interchangeable, with some women tolerating specific pills better than others, making one or several versions of the birth control pill available OTC would not benefit all current pill users,” the authors write.

I’d like to see manufacturers take the initiative to move the pill over the counter. It would address dimensions of access that insurance coverage alone cannot. But Teva’s fraught experience in moving Plan B over the counter—and the toxic political climate around contraception today, where “support” for OTC contraception is often a thinly-veiled attempt to unwind the contraceptive mandate—hardly gives pharmaceutical companies good reason to make the first move.

More related to this topic:

Adrianna (@onceuponA)

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