Victory! We won the first step in this hard-fought campaign!
For 20 years, researchers, scientists and advocates have fought to bring daily birth control pills over-the-counter in the United States, just like it is in over 100 countries around the world. Advocates for Youth has provided the youth perspective and trained young activists to ensure this fight was inclusive of all ages. In 2023, we won! Today, you can buy Opill in your local drugstores and online without a prescription, just like condoms and emergency contraception. We specifically fought for Opill to be approved for sale without age restrictions, mobilizing hundreds of young people across the country to submit comments to the FDA and nearly a dozen young people to testify live at the FDA’s Advisory Committee hearing. In July 2023, the committee voted 17-0 to authorize Opill for sale without age restrictions!
This marks the culmination of decades of work by providers, researchers, and reproductive justice organizers (including young people!) to bring a birth control pill over the counter in the United States.
So what’s next?
Now that Opill is hitting the shelves, young people are fighting to make it affordable, accessible, and available.
- Affordable: While Medicaid and private health insurance is required to cover birth control products obtained with a prescription, that requirement doesn’t currently extend to over-the-counter products. We are working hard to convince the Biden Administration to issue guidance to change that. In addition, we worked closely with the manufacturer of Opill to communicate what price points young people could afford if insurance did not cover the product. Unfortunately, we were unsuccessful in our campaign to make it $5 a month. The final list price of $20 per month is still too high for many folks to afford.
- Accessible: Thankfully, we have made much more progress on our fight for a consumer assistance program for those who cannot afford Opill at its current price. An option for receiving Opill free of charge is coming to the Opill website soon, and we are working closely with them to monitor and improve the program to serve as many young people as possible.
- Available: In the coming months, we will be monitoring where Opill is sold and advocating for student stores and vending machines to stock the product. We will also monitor if it’s kept behind lockboxes or if stores are arbitrarily keeping it behind pharmacy counters or asking for I.D. to purchase it. We will be running campaigns to ensure Opill is right on the shelves without barriers.
📣 Let’s Take Action!
Right now, our fight revolves around insurance coverage! Thanks to guidance issued by the Affordable Care Act, most private health insurance plans must cover all FDA-approved methods of contraception, but insurance plans can require a prescription first. It’s past time the Biden Administration makes clear that over-the-counter birth control, now including Opill, purchased without a prescription, must also be covered by Medicaid and all insurance plans. Over-the-counter access to birth control pills is not a replacement for insurance coverage of contraceptives.
Here’s what you can do now:
- Send a letter to President Biden and his team demanding they issue guidance requiring insurance coverage of Opill.
- Join our list here by adding your name to our petition. As you can imagine, the landscape is changing fast since the FDA approved Opill and it started hitting the shelves. If you want to stay tuned for actions we’re hosting this year to make Opill affordable, accessible and available, then add your name to the above petition (yes, we know it’s from before approval – still catching up!). By adding your name, you’ll join our email list where we’ll send updates and the latest actions.
⬇️ Behind-The-Counter: The 2022 Oral Contraceptives Access Survey ⬇️
Over the Summer of 2022, Advocates for Youth surveyed 243 people from 43 different states about their experiences trying to access birth control pills as young people and young adults. The findings paint a concerning picture that we believe every policymaker should read.
For the 55% of respondents who couldn’t get on birth control due to the constraints of the current prescription-only system, one in five experienced an unintended pregnancy. Many more suffered unnecessary stress, lost wages, and more.
It is time the United States join more than 100 countries around the world and bring The Pill over-the-counter and onto the shelves for all ages, covered by insurance. If you’d like to help us spread the word, please use this social media toolkit to do so.
See what people had to say when we brought a huge pharmacy shelf outside the White House and stocked it with birth control pills (well, sort of). Most people thought a world where birth control is over-the-counter seemed pretty normal to them.
Q: How would a pill move over-the-counter?
A: For a pill to go over the counter in the United States, a drug company will have to submit an application to the US Food and Drug Administration (FDA). Over the Summer of 2022, HRA Pharma did just that, submitting a progestin-only daily oral contraceptive for approval. The FDA held an open comment period in October, and is expected to schedule another one alongside an Advisory Committee (AdComm) hearing about it this year. At that hearing, they will hear from expert witnesses, review scientific evidence and safety data, and then vote on whether to recommend granting over-the-counter status and if any restrictions should be placed on access.
Q: What do medical professionals think about over-the-counter birth control?
A: Doctors across the country have vocally supported allowing people to buy birth control pills over-the-counter (OTC) without a prescription. Most recently, the American Medical Association (the largest, most powerful group of doctors in the country) stated, "Providing patients with OTC access to the birth control pill is an easy call from a public health perspective... Access is one of the most cited reasons why patients do not use oral contraceptives, use them inconsistently, or discontinue use. Expanding OTC access would make it easier for patients to properly use oral contraceptives, leading to fewer unplanned pregnancies.” The American College of Obstetricians and Gynecologists (ACOG), reviewed much of the published evidence documenting the safety and effectiveness of over-the-counter access to the pill, and also concluded that it should be available over the counter in the US to all ages. In addition, the American Academy of Family Physicians (AAFP) supports over-the-counter access as well, saying that oral contraceptive pills are "widely considered to be safe and effective medications," but lamenting that requiring a prescription is "restricting access" to safe and effective birth control.
Q: Will this make BC more expensive for young people who previously had it covered by insurance?
A: First of all, having an OTC option does not preclude someone from still using the prescription system and having insurance cover it, but it would provide a low-cost option for young people unable to go to a doctor. We know form our survey linked above that 88% of young people struggle to find the time or means to get to a doctor's appointment. Especially with policymakers increasingly limiting confidential options for young people to seek care, an OTC option is beocming more and more necessary. That said, cost is one of the most important barriers to care for young people, which is why we are supporting both state and federal policy solutions to expand insurance coverage to over-the-counter methods, even without a prescription. Some states have already enacted such legislation, and we are working with the federal government to determine how we can ensure insurance coverage for OTC birth control. For example, OTC COVID tests were recently covered by insurance, as were OTC hearing aides. While that system has had a number of faults, it is a good start for moving forward.
Q: Should teens really be able to get medication without going to a doctor first?
A: Teens are already capable of managing over-the-counter medications on their own. Emergency Contraception, such as Plan B, has been available over-the-counter for years without issue, and all ages can buy it. And oral contraception is safer than Tylenol or aspirin. The research done in the leadup to this moment shows that people of all ages are able to self-screen for side effects and contraindications when it comes to oral contraception.
Q: So if this is an FDA decision, what are we asking the Biden Administration to do?
A: We’re asking the Biden Administration to let the FDA do its job, and follow the science, which clearly shows that birth control pills are safe and effective and should be made available over-the-counter. We also know that the Biden Administration trusts the expertise and decision-making power of the FDA to determine that making birth control pills available over-the-counter is safe and would remove barriers to access for people all over the country.