VIEWPOINT: Why Birth Control Needs To Be Both Over The Counter And On Your Insurance Plan

(Credit: NBC News)

In February, amidst the ongoing battle over religious employers and no co-pay contraception, the Obama administration quietly issued a set of frequently asked questions to shed light on how insurance companies should implement the health reform law’s new requirement to cover contraception with no cost sharing. The FAQ makes it crystal clear that insurers must cover the full range of FDA-approved contraceptive methods — including IUDs, vaginal rings, birth control pills, and even over-the-counter (OTC) contraceptives.

The new HHS guidance is good news for those of us working to get an over-the-counter birth control pill in the US. When the American College of Obstetricians and Gynecologists recently announced its support for making the pill OTC, one of the concerns expressed was that insurance plans might not cover an OTC pill. The guidance should remove any doubt that a future OTC pill will be covered by insurance. Unfortunately, however, it still falls short by stipulating that a woman must get a prescription in order to use her insurance for OTC contraception.

Sadly, the prescription requirement defeats the purpose of having an OTC pill in the first place. Research has shown that the prescription requirement is a barrier to many women accessing and using birth control. Studies also show that women who get the pill without a prescription stay on the pill at least as long — and possibly longer — than women who have to get a prescription for refills. Women who are able to get the pill over the counter like the convenience of getting it directly in a pharmacy without a prescription, and they still see their providers for well-woman care.

Being able to pick up your pills at the store, without needing a prescription or paying additional costs, would provide relief for many women, particularly those who currently face the most barriers to getting the birth control they need on time and affordably. Young women, women of color, and immigrant women face a whole slew of obstacles both to getting their hands on a prescription and to paying out of pocket for contraception — from lack of health insurance and language barriers, to stigma and poverty. A fully covered OTC pill would knock out some of the most formidable of these.

In the case of emergency contraception — which a federal court recently ruled should be made available OTC to all women with no restrictions — we know that many women cannot afford the $30 to $50 retail price, so insurance coverage is hugely important. But having to get a prescription in order to get that insurance coverage adds unnecessary delays to accessing this time-sensitive medication.

So how can we get insurance to cover over-the-counter birth control pills — and other OTC contraceptive methods — without requiring a prescription? In fact, some states are already doing this through their Medicaid programs, using their own funds to cover over-the-counter emergency contraception without requiring a prescription. A woman can walk into a pharmacy, show her Medicaid card, and walk out with emergency contraception without paying anything. Across the Atlantic, the British National Health Service is covering birth control pills without a prescription as part of a pilot project in several London pharmacies. And in Australia, a new law allows pharmacists to dispense a pack of birth control pills to women who previously had the medication prescribed by a doctor but whose prescription has expired.

An OTC pill would be good for women because it would expand the ways they are able to access contraception and give them more control over their health. Women who run out of their prescribed pills or forget to bring them on vacation may find an OTC pill to be a critical stopgap. An OTC pill could also be an important option for women who will remain uninsured after 2014, as well as for the women employed by religious organizations that refuse to provide contraceptive coverage. And some insured women might prefer to pay a small amount for the convenience of getting the pill quickly at the pharmacy, rather than taking time off from work or school to visit their health provider. It’s also important to mention that an OTC pill, next to the condoms and spermicides on the drugstore shelf, would be the most effective contraceptive method ever sold over the counter in the US.

No-co-pay contraception and over-the-counter birth control pills and other OTC methods make sense. From a public health perspective, these things could help reduce unintended pregnancy. Covering contraception without requiring a prescription also makes sense from the perspective of the insurance company’s bottom line: birth control is cheap, while an unplanned birth is not. Perhaps most importantly, providing insurance coverage for OTC access without restrictions makes it possible for more women to make and carry out their own decisions about their reproductive lives and health.

Making contraception as available, accessible, and affordable as possible is good for women. Ultimately, ensuring that insurers will cover OTC birth control without requiring a prescription is another critical step on the path to making that goal a reality.

Our guest bloggers are a coalition of experts from several reproductive health and justice organizations, including: Kathy Ko Chin from the Asian and Pacific Islander American Health Forum; Elizabeth Dawes Gay, MPH, from the Reproductive Health Technologies Project; Daniel Grossman, MD, from Ibis Reproductive Health; Kimberly Inez McGuire from the National Latina Institute for Reproductive Health; Belle Taylor-McGhee from the San Francisco Health Commission; Cherisse Scott from SisterReach; and Britt Wahlin from Ibis Reproductive Health.