Women should be able to buy birth control pills over-the-counter at pharmacies without a prescription, a group of doctors says.
The American College of Obstetricians and Gynecologists (ACOG) said today that increasing women's access to birth control in this way could reduce the rate of unplanned pregnancies in the United States, which has not changed in the last 20 years. About half of U.S. pregnancies are unintended.
Although selling birth control pills over-the-counter (OTC) comes with risks — like any drug, the pill has potential side effects, and there are concerns it would be used by women who should not take the drug — these are outweighed by the benefits, the ACOG says.
The pill's availability would not change overnight. First, the Food and Drug Administration (FDA) would require drug companies to conduct studies proving the pill is safe for OTC use, said Claire Brindis, a reproductive health researcher at the University of California, San Francisco. For instance, the companies would need to prove that women who hadn't consulted with a doctor do indeed understand the medication's side effects and the circumstances under which they should not take it, Brindis said.
Emergency contraception (also known as the morning-after pill), which is taken to prevent pregnancy after unprotected sex, is already available over-the-counter without a prescription for women over 18.
Risks and benefits
Birth control pills can increase the risk of blood clots in some women. But this side effect is rare, and pregnancy also comes with an increased risk of blood clots, ACOG says.
"If you look at the degree to which unintended pregnancy affects women, and the risks that those unintended pregnancies carry … those risk outweigh the other risks of the medication," said Dr. Jill Rabin, an obstetrician and gynecologist at the North Shore Long Island Jewish Medical Center in New Hyde Park, N.Y.
Studies also suggest women do not need a doctor's help in determining whether they should not use the pill. (Women should not take the pill if they are pregnant or have certain conditions such as breast cancer or high blood pressure.)
"There are many medications over the counter with side effects," Rabin said. "People have to really read [the label] to see whether or not this medication that is appropriate for them."
Rabin said she agrees with the ACOG statement and hopes that should the drugs become available OTC, women would still have conversations with their doctor about which birth control pills are right for them.
Research from Mexico, where women can obtain birth control pills over-the-counter, suggests that this availability does not stop women from visiting their doctors for screening tests such as Pap smears and breast exams, ACOG says.
There are concerns that women who buy birth control pills over-the-counter would not be reimbursed by their health insurance. Efforts to improve access to birth control pills "should try to ensure that they won't increase out-of-pocket costs for women," said Dr. Kavita Nanda, who was involved writing the ACOG statement and is a scientist at the family planning nonprofit organization FHI 360.
Birth control pills range in price from $15 to $80 per month, or $180 to $960 per year.
In general, health insurance companies do not cover the cost of over-the-counter medications, said Janet Coffman, a professor at the University of California, San Francisco, who researches health policy.
Under provisions of the Affordable Care Act that take effect in 2014, insurance companies will cover prescription contraception that is FDA approved, Coffman said. But it's not clear if that coverage would apply to over-the-counter medications, she said.
It's also unclear what the price of birth control would be if it became available over-the-counter, Coffman said. There are a number of generic oral birth control pills, and with competition, prices could come down, Coffman said.
Brindis said that she hopes "health plans recognize that it's far cheaper for them to cover the cost of birth control than it is to pay for the cost of pregnancy."
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