As Democratic lawmakers push for more accessible and affordable birth control, HuffPost turned to the medical community to answer some basic questions about what it would mean for contraceptive pills to be available over the counter and covered by insurance.
Last week, Rep. Ayanna Pressley (D-Mass.) introduced the “Affordability Is Access” act, which would require insurance companies to cover oral contraception, like daily birth control pills, and have it be available over the counter without the need for a doctor’s prescription.
The House bill is co-sponsored by other female lawmakers, including Rep. Alexandria Ocasio-Cortez (D-N.Y.). And several 2020 Democratic presidential candidates have co-sponsored a companion bill in the Senate ― including Sens. Cory Booker (D-N.J.), Kamala Harris (D-Calif.), Amy Klobuchar (D-Minn.), Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.).
Under the Affordable Care Act, insurance plans are already required to cover any contraception approved by the Food and Drug Administration. The new legislation would ensure that the FDA approves “without delay” birth control pills to be sold over the counter and require that such pills be covered by insurance without cost-sharing, such as deductibles or copays.
In the past, as medical groups have pushed to make birth control available prescription-free in the U.S., people have pushed back with concerns about safety, affordability and more.
“I have no medical concerns about the pill being over-the-counter. It’s long past due for this to happen,” Dr. Daniel Grossman (no relation), a professor at the University of California, San Francisco, in obstetrics and gynecology, told HuffPost. Grossman also directs the research group Advancing New Standards in Reproductive Health (ANSIRH), which conducts policy-oriented research on contraception and more, including on making oral contraceptives over-the-counter.
“This should have happened a long time ago,” Grossman added. “The pill, from a medical perspective, is very appropriate to be available without a prescription.”
Here’s more from Grossman, as well as from an American College of Obstetrics and Gynecology (ACOG) committee paper, on what people should know about over-the-counter birth control ― and why it matters that it be covered by insurance.
Would over-the-counter birth control be safe?
The short answer is: yes. While no drug is “completely without risk of harm,” ACOG notes in its opinion on over-the-counter birth control, the overall medical consensus is that oral contraceptive use is safe. (ACOG was among several medical groups that endorsed Pressley’s legislation.)
The group noted that other commonly used drugs, like aspirin or acetaminophen, also have “documented adverse effects,” including, respectively, gastrointestinal bleeding and liver damage.
“Weighing the risks versus the benefits based on currently available data, [oral contraceptives] should be available over-the-counter,” ACOG writes.
Under the recent legislation from Democratic lawmakers, over-the-counter pills would still go through the usual regulations by the FDA to ensure safety, Grossman noted. That process would include drug companies doing research to show people can understand a simple label for over-the-counter use, for instance.
Wouldn’t having pills be over-the-counter make them more expensive?
Usually, yes ― but not in this case.
Historically when a drug has gone over-the-counter, insurance hasn’t paid for it anymore, Grossman noted. But the Democrats’ proposed legislation would require that any over-the-counter pills be covered, without copay, making them free for those who are insured.
A dozen states already allow pharmacists to prescribe birth control on site, making pills more accessible and still affordable, as they are covered by insurance.
Why does it matter that contraceptive pills be easier to access?
“Reproductive justice is not only a healthcare issue, it is also an economic issue and a civil rights issue,” Pressley said in a news release, noting her legislation “removes expensive barriers to contraceptive care ― affirming a person’s right to make decisions about their body, if and when to start a family, and their future.”
Nearly half of all pregnancies in the U.S. are unintended ― with black and Latina women experiencing higher rates of unintended pregnancies than white women.
Some of the most common reasons why women don’t use contraception, or experience gaps in contraceptive use, include access and cost, according to ACOG.
In a 2004 national survey of women, 40% of low-income women who were not using oral contraceptives or contraceptive vaginal rings said they would start using those methods if they were available from pharmacies without a prescription, ACOG noted.
“We know that low-income people and women of color have higher rates of unintended pregnancy and face barriers accessing contraception ― so from my perspective, if a pill were to go over the counter and it isn’t available at an accessible price or covered by insurance… that wouldn’t be a success,” Grossman said.
Finding the right pill can be hard, given the possible side effects ― so wouldn’t having it be over-the-counter, without a doctor’s visit, make it tougher to find one that fit?
Not any tougher than it is already. While finding the right birth control pill can be a long, at times frustrating process for people, having it available over the counter doesn’t mean you can’t see a doctor, or consult your pharmacist, for help.
“It’s important to emphasize that making the pill available over the counter will add another option, it’s not taking away options,” Grossman said.
He said that as a doctor who sees patients for contraception, it’s usually “a little bit of trial and error,” and he’s not using any special testing to figure out what will work for patients ― if they have side effects on one pill, they try another. He also noted that at first only one or two pills will likely be available over the counter, so once someone tries them, if they experience adverse effects, they could talk to a clinician or pharmacist to see what other options might be available.
If the pill is over the counter, won’t this mean people ― generally women ― won’t go as often to get a gynecological check-up and get cancer screenings or STD checks?
“I think it’s very paternalistic that we hold birth control hostage and force people to come in and get services that are important but unrelated to contraception ― like forcing them to get a Pap smear or testing for sexually transmitted diseases,” Grossman said. “It just doesn’t make sense.”
“I can’t think of any example in medicine where men are forced to do something like that or they won’t get some other treatment that is unrelated,” Grossman added.
Screening for cervical cancer or sexually transmitted diseases is “not medically required” to provide hormonal contraception, ACOG noted. And such screenings “should not be used as barriers to access” to birth control, the group said.
Do other countries allow people to get birth control without a doctor’s prescription?
As with many issues when it comes to reproductive justice, the U.S. lags behind other countries.
For contraceptive pills, people in the U.S., Canada and much of Europe still need doctors’ prescriptions to get them. But in dozens of other countries, people can already easily get them without a prescription, including in Portugal, India, China and Mexico.
“I think it’s time we catch up,” Grossman said.
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