“Pills are one of the most commonly used contraceptives, and over-the-counter access removes many barriers to pill use and continuation.” (Photo: Shutterstock)
Starting January 1, Oregon became the first state where women can buy birth control pills and patches directly from a pharmacy—without having to visit an ob-gyn for a prescription first. The same will go for California residents starting in March (the ring will be included, too), and a similar bill is up for proposal in Colorado.
Here’s the catch, though: These methods of birth control still aren’t as easy to get your mitts on as, say, antacids or allergy meds. Even though they’re being touted as available over-the-counter meds (the definition of which is no script necessary), they’re not technically that: You actually still need a prescription—but from a pharmacist, not an M.D. So, it’s cutting out the step of the doctor’s appointment but not eliminating the need to be evaluated by a medical professional.
That being said, this does sound a heck of a lot easier than booking face-time with your gyno and then hitting up your local drugstore, right? But when it comes to your sexual health, is this really the safest way to go about obtaining BCPs? And will it really make access easier for more women? We asked four gynecologists, all of whom are Bedsider.org advisers, to weigh in:
“The major benefits are fewer access barriers to safe, effective contraception and to refills for contraceptives, allowing better adherence to these methods. Pharmacists are highly trained professionals and may assist women with access to these contraceptives. However, the need for a pharmacist will still constitute a barrier for some women—ideally, these contraceptives would be over-the-counter with appropriate self-screening for contraindications.” – Eve Espey, M.D., professor and family planning fellowship director, department of ob-gyn, University of New Mexico
“These are safe and excellent methods of birth control that should not require an appointment with a health-care provider to obtain. With a few screening questions, someone can decide whether or not they are safe given their own medical history. I think cutting out a need for obtaining health insurance or taking time off of work in order to complete a health-care appointment is a great way to make these safe contraceptive methods more accessible.
I think a pharmacist is quite capable of providing the necessary screening for these contraceptive medications. A main drawback I foresee is cost continuing to be a barrier. Health insurance will cover these methods, but those without health insurance still may face the obstacle of being able to afford the medication even though it is OTC. I sincerely hope that in the efforts to make these methods more accessible, costs are also kept down such that OTC will actually benefit many. Otherwise, we have really done nothing to make these methods more accessible.” – Leah Torres, M.D., ob-gyn in Salt Lake City
“OTC access for oral contraceptive pills has been supported by American Congress of Obstetricians and Gynecologists since 2012. There are several benefits to this. Pills are one of the most commonly used contraceptives, and over-the-counter access removes many barriers to pill use and continuation. I have had many patients who have had interrupted pill use because of the logistics of getting to the doctor’s office for a prescription or the inability to get back to the pharmacy for a refill. Since fertility can return almost immediately after stopping the Pill, I have seen interrupted access to the pill lead to unplanned pregnancy.” – Colleen Krajewski, M.D., ob-gyn in Pittsburgh
“This could be particularly helpful if a woman runs out of her birth control and can’t quickly get a refill. My biggest concern is who will pay for this—I doubt that pharmacists will be willing to take the extra time to evaluate and counsel women if they don’t receive some payment for providing this service. This model was first developed in Washington State, and ultimately it wasn’t used much because insurers didn’t reimburse for the pharmacist screening, and women weren’t interested in paying themselves. Hopefully this time insurance will cover this.
“Another drawback is that these methods will only be available when a pharmacist is available and the pharmacy is open. So it’s not quite as good as making the Pill available truly over-the-counter, which would not require a pharmacist’s involvement. A minor concern I have is that we know some pharmacists have refused to provide emergency contraception, and I worry that some will refuse to provide regular hormonal birth control. I don’t believe that this will deter women from going in for their yearly gynecological exams, though. We have evidence from other settings where women get pills over-the-counter that they continue to get recommended screening for cervical cancer and sexually transmitted diseases.” – Daniel Grossman, M.D., professor, department of obstetrics, gynecology, and reproductive sciences and director, advancing new standards in reproductive health at the Bixby Center for Global Reproductive Health at the University of California, San Francisco
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