Over-The-Counter Birth Control? Bring It On

Jeffrey A. Singer

Last week Rep. Alexandria Ocasio-Cortez, the New York Democrat, tweeted that oral contraceptives should be made available over-the-counter. A few days later, Sen. Ted Cruz, Texas Republican, tweeted he agrees and offered to team up with Ocasio-Cortez on legislation to make it happen. The American College of Obstetricians and Gynecologists has called for making birth control pills available without a prescription for years; The American Academy of Family Physicians agrees.

Now that two prominent legislators of such divergent political persuasions have expressed their concurrence with the medical experts, perhaps the time is nearing when the U.S. will join 102 other countries throughout the world and allow women to obtain birth control pills without a prescription.

Defenders of the status quo fear women may forgo necessary preventive care visits if birth control pills are available over the counter. But the ACOG states that “cervical cancer screening or sexually transmitted infection (STI) screening is not required for initiating OC [oral contraceptive] use and should not be used as barriers to access.” In fact, there is currently a debate among gynecologists regarding the need and benefits of annual pap exams.

The confluence of views among women of child-bearing age, medical experts, and now legislators from both ends of the political spectrum provides a great opportunity to liberate women from the paternalistic policy that makes them pay a toll – a doctor’s office visit – to obtain contraception.

Others paternalistically worry that women may misuse oral contraceptives if they are able to obtain them without a permission slip (prescription) from another equally autonomous adult. Yet experience shows that when adults self-medicate, they conscientiously perform due diligence, whereas they otherwise defer to the judgment of authority figures if medications are prescribed. For example, a 2006 report from Seattle found women’s self-evaluation regarding whether or not they should take the pill matched those of doctors about 90% of the time — and the 10% of the time they didn’t match was mostly because the women were more cautious.

Ten states have tried to work around the FDA’s prescription classification by allowing pharmaciststo prescribe birth control pills. While that’s an improvement over the status quo, it still negatively affects women’s comfort and privacy. As shown in a 2015 report in the journal “Sexual and Reproductive Healthcare,” many women who seek emergency contraception (the so-called morning after pill, which has been available over-the-counter since 2006) prefer to purchase this kind of medication discreetly and avoid unwanted discussion or counseling, even if offered by a health care professional.

The obstacles created by the prescription status of oral contraceptives may be one reason why many women stop taking them after just one year. Many states are now permitting the prescription of 12-month supplies as opposed to the three-month maximum supply that has been the general rule. That’s a step in the right direction. In its 2012 call to reclassify birth control pills as nonprescription drugs, ACOG cited research from the University of Texas that compared the use of oral contraceptives across the U.S.-Mexico border at El Paso/Ciudad Juarez — oral contraceptives are available over the counter in Mexico. The researchers concluded that providing users of oral contraceptive pills “with more pill packs and removing the prescription requirement would both lead to increased continuation.”

Another potential benefit of ending the prescription requirement for oral contraceptives is cost savings. Prices of oral contraceptives, which currently average between $20 to $50 per month but range as low as $9 per month, might come down further once they can be sold over the counter and are rendered vulnerable to greater competition and consumer scrutiny.

According to FDA regulations, a petition to reclassify a drug from prescription to nonprescription/over-the-counter status can come from a manufacturer, any “interested party,” or the FDA commissioner. Congress can also legislate reclassification. That’s where Cruz and Ocasio-Cortez could have an impact.

The confluence of views among women of child-bearing age, medical experts, and now legislators from both ends of the political spectrum provides a great opportunity to liberate women from the paternalistic policy that makes them pay a toll — a doctor’s office visit — to obtain contraception.

Dr. Jeffrey A. Singer practices general surgery in Phoenix, Arizona and is a senior fellow at the Cato Institute.