“With insurance companies regulating how many months supply of birth control people can get at one time, in most places, it’s not possible to get extra birth control, as the CDC has recommended doing with necessary medications.”
More than 300 million Americans in 43 states have been asked to stay at home as much as possible to help curb the spread of the novel coronavirus. Public health officials have advised people to “stock up” on essentials including food and life-sustaining medications. But what about prescriptions that aren’t life-sustaining?
For people who use the birth control pill, being able to get their prescriptions filled in advance may prove to be complicated.
“With insurance companies regulating how many months supply of birth control people can get at one time, in most places, it’s not possible to get extra birth control, as the CDC has recommended doing with necessary medications,” said Britt Wahlin, vice president for Development and Public Affairs at Ibis Reproductive Health, the research organization behind the Free the Pill campaign. “A few states require insurers to dispense a year’s supply of birth control at one time, but this option should be available everywhere.”
Unplanned pregnancies in the U.S. account for nearly half of all pregnancies. According to the Guttmacher Institute, 45% of pregnancies were unintended in 2011. Furthermore, 18% of pregnancies were considered “unwanted.” Making the birth control pill—which has other benefits aside from preventing pregnancy, including reducing period paid and mitigating the risk of certain cancers—available over the counter without a prescription would be beneficial to the one in three women who want it, according to Free the Pill.
In order for the birth control pill to be truly accessible, Wahlin said it must be affordable, available over the counter, and fully covered by insurance. Accessibility has long been the biggest barrier when it comes to contraception, especially the pill.
According to a study by the American College of Obstetrics and Gynecology (ACOG) in 2012, the requirement for a prescription can be an obstacle for contraceptive users. Out of the 1,385 women surveyed for the study, 68% reported that they tried to obtain a prescription for hormonal contraception, and 29% of those women reported experiencing a problem with accessing the initial prescription and/or refills.
These obstacles included the cost of provider visits, lack of insurance, challenges in getting an appointment with a provider, reliable transportation, the provider requiring an in-person examination or Pap test, childcare, and difficulty accessing a pharmacy.
A global pandemic has heightened these challenges. If, for instance, your prescription were to run out this month, it’s unlikely that you’ll be able to get in to see your doctor to get a new one. The White House has extended the stay-at-home recommendations through April 30, and asked Americans to consider postponing routine doctor visits and procedures until the outbreak is over.
Additionally, college students across the country were forced to abandon their campuses almost two months earlier than planned, leaving many without access to campus health centers for birth control refills.
“Access to reproductive health care, including birth control, is essential during a public health crisis,” Wahlin said. “The COVID-19 pandemic has exacerbated existing barriers to birth control that disproportionately impact young people, people of color, and people struggling to make ends meet.”
The Guttmacher Institute’s research shows unintended pregnancy rates are highest among low-income women (women with incomes less than 200% of the federal poverty level), women between the ages of 18-24, women who live with a partner, and women of color.
In order for the birth control pill to become available over the counter in the U.S., drug companies would have to submit an application to the U.S. Food and Drug Administration (FDA). The process after that lasts about three or four years until the pill is available on store shelves. At this time, no company has submitted an application, according to Free the Pill.
One noteworthy supporter of improving access to hormonal contraception by making it available without a prescription is ACOG. “Several studies have demonstrated that women are capable of using self-screening tools to determine their eligibility for hormonal contraceptive use,” the medical association wrote in its most recent guidance on the issue. “Age should not be a barrier for access to hormonal contraception.”
“Evidence demonstrates that women want over-the-counter access to hormonal contraception because it is easier to obtain,” the guidance states, adding that pharmacist-provided contraception may be a necessary intermediate step to increase access to contraception. Currently, Washington D.C. and 10 states—California, Colorado, Hawaii, Maryland, New Hampshire, New Mexico, Oregon, Tennessee, Washington, and Utah—allow people to get their birth control directly from a pharmacist with a screening process.
“But over-the-counter access to hormonal contraception should be the ultimate goal,” ACOG states.
Of course, cost and insurance coverage are still a cause for concern for many. Under the Affordable Care Act, most private insurance companies must cover all types of FDA-approved birth control for women without any cost-sharing (like a copay). This means that your insurance would cover it, most likely, but only with a prescription.
Services like Telehealth and Nurx.com make it easier for patients to access birth control pills without an in-person medical consultation or examination. Nurx will even work with uninsured patients on affordable options for medication. But these services still cannot offer the ease of over-the-counter access.
“With people needing to stay home and practice social distancing during this public health crisis, the ability to access birth control at your local drugstore while you’re picking up other necessities is essential to bridging critical gaps in access for everyone,” Wahlin said. “This moment highlights why an over-the-counter birth control pill is crucial to meeting people’s health care needs.”