About half of all pregnancies in the United States are unintended. But if birth control pills were available over the counter and covered by insurance, the rate of unintended pregnancies could drop by as much as 25 percent, according to a study published Friday in the journal Contraception.
The study by researchers at the University of California, San Francisco, and the nonprofit Ibis Reproductive Health, found that if women were able to buy the pill at any pharmacy without a prescription and have it covered by their insurance, there would be an 11 percent to 21 percent rise in the number of women using birth control pills, and the rate of unintended pregnancies in the U.S. would drop 7 percent to 25 percent.
“Women who are currently using methods that are less effective than the pill — mainly condoms or nothing — would use it,” said Dan Grossman, author of the study. “Particularly low-income women.”
Insurance companies would have lower costs as well, because they would have fewer unintended births to cover.
Most women now can obtain birth control without copayment through their insurance plans, thanks to the Affordable Care Act. But the pill requires a doctor’s prescription, and Grossman said that remains a barrier for many women. Selling the pill over the counter would add a wrinkle, since many insurance plans don’t cover OTC medicines without a prescription.
“In the era of no-co-pay contraception, there is still a need for over-the-counter birth control to fill the gap when women run out of pills while traveling, for example, or for those who find it inconvenient to get to a clinic,” Grossman said. “But to reach the largest number of women most in need, it’s critical that a future OTC pill be covered by insurance.”
The idea of making birth control available over the counter has been around for a long time and is supported by reproductive health organizations like Planned Parenthood. It gained momentum during the 2014 midterm elections, as Republican candidates touted their support for over-the-counter birth control as an alternative to the requirement in Obamacare that all insurance plans cover contraception without out-of-pocket costs to the woman.
The problem with that proposal, Grossman said, is that making birth control available without a prescription is not effective if women can’t afford it, because women’s use of birth control pills sharply declines as the cost of a pack exceeds $20. A month’s supply of birth control pills can cost up to $162 without insurance. “Using an over-the-counter birth control pill is very correlated to how much it’s going to cost,” Grossman said.
Sen. Cory Gardner (R-Colo.), who championed over-the-counter birth control in his Senate campaign last year, said Republicans are “figuring out a direct policy to move forward with” on the issue, but he did not elaborate. Republicans are generally opposed to requiring insurance companies to cover birth control.
“If insurance companies cover it, they cover it,” Gardner said of a hypothetical over-the-counter contraceptive.
Democrats, meanwhile, are skeptical of Republican efforts to expand access to birth control pills while simultaneously trying to strip away the requirement for insurance coverage of them. If employers no longer had to cover the full range of contraceptives, costs would skyrocket for women who use long-acting methods, like the intrauterine device.
“Until [Republicans are] interested in something that would protect both access and affordability, this is just politics,” said one Senate Democratic aide.
Ultimately, the Food and Drug Administration decides whether contraception can be made available without a prescription. It would require a pharmaceutical company to do research about the safety of a particular pill and formally apply to the FDA, as Teva Women’s Health did for the morning-after pill Plan B in 2014.
Grossman said Republicans may have already encouraged that process by indicating that they wouldn’t try to block it.
“There isn’t anything politicians can do to make the pill over the counter, despite what some of the Republican candidates said in the last election,” Grossman said. “But if at the very least they would stay out of this, there would be more interest from pharmaceutical companies.”
Planned Parenthood Action Fund president Cecile Richards said she would applaud making the pill available over the counter.
“We strongly support making birth control available over the counter, as part of our nearly 100-year history of expanding access to birth control,” Richards said. “Every woman in America should have access to the birth control method that’s best for her, without barriers based on cost, availability, stigma, or any other hurdle.”
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