Over-the-Counter Oral Contraceptive Pills | KFF


Oral contraceptives are the most commonly used means of reversible birth control within the U.S. Oral contraceptive capsules have been first authorised for prescription use via the U.S. Meals and Drug Management (FDA) in 1960. Over 70 years later, on July 13, 2023, the FDA authorised Opill, the primary day by day oral contraceptive tablet to grow to be to be had over the counter (OTC) and not using a clinician’s prescription. It’s going to be to be had on-line and in retail outlets in early 2024 to other people of every age. Opill was once to begin with authorised for prescription use via the FDA in 1973 (via a unique producer and with a unique logo identify). This factor temporary supplies an outline of OTC oral contraceptives and regulations and insurance policies associated with insurance plans.

Protection and Efficacy

Oral contraceptive capsules are extremely efficient at preventing pregnancy with “absolute best use,” with a failure charge of not up to 1%. Then again, the failure charge with “conventional use,” which accounts for inconsistent or improper use, is 9%. Oral contraceptive capsules should be taken as soon as according to day and are basically used for being pregnant prevention, however they are able to even be used to deal with different well being prerequisites equivalent to menstrual ache, abnormal menstruation, fibroids, endometriosis-related ache, menstrual-related migraines, and zits control. Oral contraceptives, particularly progestin-only capsules, are protected for most ladies.

Oral contraceptive capsules, particularly progestin-only capsules, are protected for most of the people to make use of and feature an overly low chance of significant unwanted effects or contraindications. Imaginable unwanted effects from the tablet come with headache, nausea, breast tenderness, and leap forward bleeding. Research has discovered that individuals, together with the ones below the age of 18, are in a position to know label directions and contraindications for OTC birth control with out clinician involvement.

Even if it’s not as a long way alongside within the FDA approval procedure, any other pharmaceutical corporate, Cadence, is operating towards FDA approval of an OTC model of its blended (progestin and estrogen) oral contraceptive tablet, Zena. Mixed oral contraceptive capsules have extra contraindications and small, however upper, dangers of significant unwanted effects than progestin-only capsules like Opill. They’re believed to be reasonably more practical at combating being pregnant than progestin-only capsules and whilst in addition they should be taken each day, there may be extra flexibility at the actual timing.

Analysis on OTC Get entry to

Over the counter (OTC) standing is an FDA designation which means {that a} drug or product is to be had and not using a prescription from a doctor. The power to get right of entry to oral contraceptives and not using a prescription from a clinician can save time spent on trip, at a physician’s place of job, and stale paintings. Studies recommend that OTC get right of entry to to oral contraceptives may just build up using birth control, facilitate continuity of use, and reduce the risk of unintentional being pregnant. Different analysis means that OTC oral contraceptives can particularly get advantages populations who’ve traditionally confronted boundaries to gaining access to contraceptive care, equivalent to young adults and adolescents, those that are uninsured, and the ones dwelling in contraceptive deserts or spaces with restricted get right of entry to to well being facilities providing the total vary of contraceptive strategies.

Moreover, the nationally consultant 2022 KFF Women’s Health Survey discovered that greater than one-third (36%) of reproductive-age feminine respondents who use oral birth control have overlooked taking it on time as a result of they weren’t in a position to get their subsequent provide (Determine 1). The added comfort and time stored via acquiring oral birth control OTC as a substitute of getting to discuss with a physician may just cut back the proportion of ladies who omit taking their birth control on time.

Client Hobby in Over-the-Counter Get entry to

The nationally consultant 2022 KFF Women’s Health Survey discovered that greater than three-quarters (77%) of feminine respondents ages 18-64 preferred making start regulate capsules to be had over-the-counter and not using a prescription if analysis confirmed they’re protected and efficient, and two in 5 (39%) mentioned they might be most likely to make use of FDA-approved OTC start regulate capsules that don’t require a prescription. This percentage is even upper amongst those that already use oral birth control (60%), Hispanic respondents (46%), and those that have been uninsured (41%). Comfort is the main explanation why that reproductive-age feminine respondents mentioned they might be moderately or very most likely to make use of OTC start regulate capsules. Another study discovered that teenagers also are inquisitive about the use of OTC start regulate capsules, particularly if they’re coated via insurance coverage.

The similar 2022 KFF survey discovered that amongst reproductive-age feminine respondents who mentioned they might be not going to make use of OTC start regulate capsules or weren’t positive, 12% cited protection issues as the primary reason and 16% mentioned their primary explanation why was once that they most popular to speak to a physician sooner than beginning or refilling start regulate. It will have to be famous that those that decide to make use of Opill (or some other OTC contraceptive means) all the time have the opportunity of consulting their well being care supplier sooner than beginning or refilling that means.

Different OTC Birth control

Levonorgestrel emergency contraceptive (EC) pills, referred to as “the morning after tablet” and advertised as Plan B One-Step and different manufacturers, are a type of backup start regulate meant to be taken a number of days after unprotected intercourse or contraceptive failure. Levonorgestrel EC capsules have been the primary hormonal birth control to have switched from prescription to OTC standing, in 2006. In contrast to day by day oral contraceptives, emergency birth control isn’t meant for day by day use and is FDA authorised to be used via ladies inside of 72 hours (3 days) after unprotected sex or contraceptive failure to forestall being pregnant.

Different contraceptive merchandise which are to be had over-the-counter and not using a prescription come with female and male condoms, spermicides, and contraceptive sponges. Those contraceptive strategies are much less efficient than oral birth control at combating being pregnant. FDA’s approval of Opill makes it among the finest type of birth control to be had over-the-counter meant for normal use.

Federal Rules on OTC Contraceptive Protection

Personal Insurance coverage

The Reasonably priced Care Act (ACA) calls for maximum non-public well being plans (workforce and person) to hide, totally free sharing, the total vary of FDA-approved contraceptive strategies, which incorporates oral contraceptive capsules. The ACA duties the Well being Sources and Products and services Management (HRSA) with protection necessities for a variety of preventive services and products for girls, which now contains birth control, that should be coated via insurance coverage. Proper after the ACA was once handed, HRSA tasked the Institute of Medication (IOM) to spot gaps in preventive suggestions. This committee recognized contraceptive services and products and provides as one of the crucial eight gaps in preventive well being services and products to advertise ladies’s well being. The IOM really useful that each one FDA-approved contraceptives be integrated as preventive services and products, and the HRSA protection requirement for birth control integrated that they be coated “as prescribed,” which was once mirrored within the unique guidance issued via the Obama management in 2013.

Recently, HRSA has commissioned the Ladies’s Preventive Products and services Initiative (WPSI) because the professional frame it is determined by to replace and make bigger preventive services and products protection suggestions, which WPSI ultimate up to date in 2021. The current protection requirement posted via HRSA not features a prescription requirement for protection of birth control, however the U.S. Departments of Hard work, Well being and Human Products and services, and Treasury (federal tri-agency) steerage has now not been revised to drop the “as prescribed” requirement.

The prescription requirement is these days solely discussed in federal FAQs clarifying ACA protection necessities, with the most recent one issued via the Biden management in July 2022. The FAQ references protection of emergency birth control and states that plans should quilt OTC contraceptives when the product is prescribed. It additionally states that plans are “inspired to hide OTC emergency contraceptives and not using a charge sharing when they’re bought and not using a prescription.” In June 2023, the Biden management issued an executive order directing the federal tri-agencies to believe new movements to strengthen get right of entry to to reasonably priced OTC birth control, together with no-cost protection.

OTC drugs and merchandise don’t require a prescription for acquire, however most of the people wishing to keep away from cost-sharing for them want to download one. The prescription requirement re-introduces one of the most similar boundaries that have been meant to be decreased with OTC standing equivalent to getting rid of the want to make and stay up for a physician appointment or discover a pharmacy whose pharmacists are approved and to be had to prescribe birth control (the place approved via state regulation).


Medicaid is the general public medical insurance program that covers roughly 20% of low-income kids, adults, seniors, and other people with disabilities. Medicaid is collectively financed via the government and the states. Federal statute units large minimal requirements in trade for federal matching finances and states have flexibility in figuring out different facets in their Medicaid techniques equivalent to coated services and products and supplier cost fashions.

Protection for contraceptives is a key part in Medicaid protection of circle of relatives making plans services and products. All states quilt prescribed drugs, even if it’s technically an “non-compulsory” get advantages class below federal regulation. Federal laws require state Medicaid techniques that quilt prescribed drugs (together with OTC medication with a prescription) to hide all prescribed drugs from producers that experience entered right into a federal rebate settlement with the U.S. Secretary of Well being and Human Products and services, despite the fact that states would possibly decide whether or not and make use of usage control controls. To be able to download federal matching finances, a prescription is needed for over the counter medication and merchandise.

Federal regulation additionally calls for state Medicaid techniques to cover family planning services and provides with out cost-sharing to enrollees. The federal Medicaid regulation does now not outline what services and products should be integrated and in addition does now not explicitly cite OTC contraceptives as a part of the protection requirement, however most state Medicaid techniques quilt a variety of contraceptive strategies, and a few quilt OTC strategies. The ACA calls for states to hide no less than one type of all 18 FDA-approved contraceptive strategies for enrollees who qualify during the ACA’s Medicaid growth. Basically, those services and products are outlined and decided via the states inside of large federal tips.

With few exceptions (equivalent to prenatal nutrients, fluoride arrangements for pregnant other people, and tobacco cessation merchandise), federal regulation does now not require states to hide OTC medication and merchandise of their Medicaid techniques. Then again, state Medicaid techniques can decide to hide them via filing a state plan modification (SPA) to CMS, the federal firm that administers Medicaid in partnership with state Medicaid companies. As an example, CMS authorised SPAs from Delaware, Montana, and Florida soliciting for to hide choose OTC medication usually. After acquiring approval from CMS to hide OTC merchandise usually, states can make a selection which OTC merchandise their program will quilt. Then again, even if a drug is to be had to buy and not using a prescription, enrollees normally desire a prescription to acquire protection and states can not download federal matching greenbacks until it’s prescribed. If states need to come with protection for OTC merchandise and not using a prescription, state Medicaid techniques would possibly decide to make use of state-only finances.

State Rules on OTC Contraceptive Protection

State-regulated non-public medical insurance

To scale back get right of entry to boundaries to OTC birth control whilst additionally heading off charge sharing, six states (CA (efficient in 2024), MD, NJ, NM, NY, and WA) have regulations or laws requiring state-regulated non-public medical insurance plans (person, small workforce, and big workforce markets) to hide, totally free sharing, no less than some strategies of OTC birth control and not using a prescription (Determine 2). Except for New York, which applies solely to emergency birth control, the language of those regulations is large sufficient to surround an OTC day by day oral contraceptive equivalent to Opill and not using a trade in coverage. (See KFF State Health Facts for extra main points on each and every state’s regulation, together with contraceptive strategies coated.)

Illinois and Oregon require non-public well being plans to hide OTC birth control; then again, whilst the regulations don’t state {that a} prescription is needed to ensure that it to be coated via insurance coverage, the regulations additionally don’t explicitly stipulate that plans should quilt them and not using a prescription. Delaware and Massachusetts require non-public plans to hide OTC emergency birth control with a prescription or pursuant to a status order or protocol. A status order lets in a doctor of a state well being division or different state firm to authorize pharmacists to prescribe medication or supply care below sure prerequisites set forth within the order.

Whilst federal regulation applies to all plans, state regulation applies to simply person plans and fully-insured workforce plans. Subsequently, many of us who are living in states that require protection of OTC birth control and not using a prescription won’t have this protection if they’re enrolled in a self-funded employer-sponsored well being plan (65% of coated staff nationally).


To extend get right of entry to to birth control, seven states (CA (efficient in 2024), IL, MD, MI, NJ, NY, and WA) have opted to make use of state-only finances to hide no less than some strategies of OTC birth control for his or her Medicaid enrollees (basically emergency birth control) and not using a prescription (Determine 2). Except for California, the language of those state-level insurance policies does now not seem large sufficient to surround an OTC day by day oral contraceptive tablet equivalent to Opill and not using a trade in coverage. (See KFF State Health Facts for extra main points on each and every state’s coverage, together with contraceptive strategies coated.)

Demanding situations to the Huge Adoption of OTC Oral Birth control

There are some boundaries to the prospective succeed in of an over the counter progestin-only tablet (POPs). Whilst each POPs and blended capsules (COCs) are safe and effective at combating being pregnant, POPs are believed to be reasonably much less efficient than COCs. It is strongly recommended that customers of POPs take the tablet on the similar time each day, which generally is a barrier for individuals who aren’t in a position or would disregard to try this. Then again, there may be limited evidence that adhering to this actual time frame in truth reduces the efficacy of POPs.

Opill’s succeed in is also restricted as a result of few ladies who use oral contraceptive capsules use POPs and as a substitute decide to make use of COCs. Recently, the main customers of POPs are breastfeeding ladies as a result of they’re protected for this inhabitants, and they aren’t prompt to make use of COCs throughout this time. Whether or not customers of COCs will decide to change to Opill for causes equivalent to comfort or charge isn’t but identified.

Moreover, outlets can make a selection whether or not and inventory Opill. Shops who make a selection to promote it’ll additionally make a decision which offer choice (one, 3, or six-month packs) to inventory. As is the case with emergency birth control at many outlets who inventory it, Opill may well be stored in a locked case at the shelf or in the back of the drugstore counter to scale back the risk of robbery, which might create get right of entry to boundaries.

The level to which OTC oral birth control is out there will rely, largely, on affordability and protection. The pharmaceutical corporate that has submitted an FDA software to change its oral contraceptive from prescription-to-OTC standing has now not but made pricing publicly to be had. KFF’s 2022 Women’s Health Survey discovered that 11% of ladies would now not be prepared or in a position to pay the rest for an OTC oral contraceptive, and 39% would pay $1-$10 monthly. Most effective 16% mentioned they might pay greater than $20 a month. Different research that requested in particular a couple of progestin-only tablet discovered that grownup ladies could be prepared to pay $15 monthly and youths ages 15-17 would pay $10. Insurance policy of OTC oral birth control and not using a prescription would do away with out-of-pocket prices, however for many who favor to not use their insurance coverage or those that shouldn’t have insurance coverage, the associated fee level will topic.

The place insurance coverage will quilt Opill, until required via state law, plans will decide what number of months’ provide they are going to quilt at one time. Opill will likely be to be had in one-, two-, three-, or six-month provides. For the ones intending to make use of Opill incessantly, research has documented the significance of making sure other people have ok provide in adherence to their contraceptive means and insurance plans of a longer provide can lend a hand facilitate this.


Oral contraceptive capsules, particularly progestin-only capsules, are protected to make use of and feature an overly low chance of significant unwanted effects or contraindications. The FDA’s approval of Opill, the primary day by day OTC oral contraceptive, which removes the prescription requirement, may just make bigger its accessibility. Then again, the level of accessibility will in large part rely on availability, affordability, and insurance plans. Whilst some states require non-public plans and Medicaid to hide non-prescribed OTC birth control, now not everybody in the ones states is assured this protection. Absent federal steerage, assured protection of OTC oral birth control and not using a prescription will proceed to rely on the place other people are living and their form of well being plan.


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