OTC Birth Control Could Expand Access

The American College of Obstetricians and Gynecologists (ACOG) recently released new guidelines for hormonal contraception that support over-the-counter access.¹

OTC options for hormonal birth control have been discussed for years, with various options and solutions proposed. Increased access via birth control apps and various contraceptive options in vending machines have been popular, and multiple studies have shown that women, pharmacists, and physicians broadly support increased access.

Kelly Blanchard, MSc, president of Ibis Reproductive Health, said increasing access to contraceptives is vital to improving patients' wellbeing. It broadens their choices, she said, allowing them to pursue higher education and participate more in the workforce.

“We know that in the current prescription environment, people face barriers to accessing contraception,” Blanchard said. “But we’re really trying to overcome those barriers.”

Those barriers can make accessing contraceptives almost impossible, especially for those who are uninsured and non-English speaking. According to a study published in the Journal of Women’s Health, frequently cited barriers include cost or lack of insurance; challenges getting an appointment or getting to a clinic; the physician requiring a clinic visit, exam, or Pap smear; lack of a primary provider or clinic; and difficulty accessing a pharmacy. One-third of adult women in the United States who have ever tried to access prescription contraception reported access barriers.²

A 2013 study found that of 2046 US women who completed a survey, 62.2% said they were strongly or somewhat in favor of over the counter (OTC) access to oral contraceptives. Of the participants, 37.1% said they were likely to use oral contraceptives if they were available as OTC products.³

While some opponents argue that adverse events could increase due to the lack of screening by a health care provider, the ACOG guidelines pointed out a possible intermediate step before full OTC access is achieved: pharmacy access, also called “behind-the-counter access.”¹

Under this model, patients would consult with a pharmacist before receiving the medication, and the screening would include a questionnaire to identify potential contraindications as well as a blood pressure measurement.¹

A study of pharmacists found that 85% expressed interest in providing hormonal contraception, although potential obstacles included lack of time, reimbursement concerns, and possible resistance from physicians.⁴

Blanchard said that the pharmacy access model is a step in the right direction.

“We think [OTC contraceptives] support the idea that pharmacists are a critical part of the health care system,” she said. “We really see this as an extension of current strategies, where pharmacists themselves are prescribing and providing birth control.”

In order for hormonal birth control options to hit the OTC market, Blanchard said a pharmaceutical company needs to come forward to move their drug into the OTC sector, something she said she hasn’t seen a willingness to pursue until recently.

“The safety and effectiveness data really show that birth control should be available OTC,” she said.

REFERENCES

• American College of Obstetricians and Gynecologists. Access to Hormonal Contraception. ACOG website. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Access-to-Hormonal-Contraception. Published September 24, 2019. Accessed September 25, 2019.
• Grindlay K and Grossman D. Prescription birth control access among a representative sample of us women at risk of unintended pregnancy. Contraception, 2013:88(3), pp.452-453.
• Grossman D, Grindlay K, Li R, Potter J, Trussell J, and Blanchard K. Interest in over-the-counter access to oral contraceptives among women in the United States. Contraception, 2013:88(4), pp.544-552.
• Cohen S, Chung F, Greene-Foster D, and Taylor-McGhee B. Pharmacist interest and attitudes toward pharmacy access to hormonal contraception. Contraception, 2005:72(#), p.240.