As Democratic lawmakers push for more accessible and affordable birth control, HuffPost turned to the medical community to answer some key questions about what it means for over-the-counter contraceptive pills and coverage of insurance.
Last week, Rep. Ayanna Pressley (D-Mass.) the “Affordability Is Access” act, which require insurance companies to cover oral contraceptionlike the daily birth control pill, and dispense it over the counter without needing a doctor’s prescription.
The House bill was co-sponsored by other female lawmakers, including Rep. Alexandria Ocasio-Cortez (DN.Y.). And how many 2020 Democratic presidential candidates are co-sponsored a fee included in the Senate ― including Sens. Cory Booker (DN.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 required to cover any contraception approved by the Food and Drug Administration. The new law would ensure that the FDA approves “without delay” birth control pills sold over the counter and requires that such pills be covered by insurance without cost sharing, such as deductibles or copays.
In the past, such as medical groups pushed to make birth control available without a prescription in the US, people have pushed concerns about safety, affordability and more.
“I have no medical concerns about the over-the-counter pill. It’s long past due for this to happen,” said Dr. Daniel Grossman (no relation), a University of California, San Francisco, professor of obstetrics and gynecology, told HuffPost. Grossman also leads the research group Advancing New Standards in Reproductive Health (ANSIRH), which conducts research focused on contraception policy and beyond, including the development of over-the-counter oral contraceptives.
“This should have happened a long time ago,” Grossman added. “The pill, from a medical point of view, is very suitable to be available without a prescription.”
Here’s more from Grossman, as well as from a committee of the American College of Obstetrics and Gynecology (ACOG). paper, on what people should know about over-the-counter birth control ― and why it’s important that insurance covers it.
Will over-the-counter birth control be safe?
The short answer is: yes. Although no drug is “absolutely free of the risk of harm,” ACOG says here opinion on over-the-counter birth control, the general medical consensus is that oral contraceptive use is safe. (ACOG is among several medical groups that have endorsed Pressley’s law.)
The group noted that other commonly used drugs, such as 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 wrote.
Under recent legislation from Democratic lawmakers, over-the-counter pills would still go through standard FDA regulations to ensure safety, Grossman said. That process includes drug companies doing research to show people understand a simple label for over-the-counter use, for example.
Wouldn’t it be more expensive to have over-the-counter pills?
Usually, yes ― but not in this case.
According to Grossman, once a drug is over-the-counter, insurance no longer pays for it. But the Democrats’ proposed law would require that any over-the-counter pills be covered, without a copay, making them free for the insured.
A dozen states already allow it pharmacists will prescribe birth control on site, making the pills more accessible and still affordable, as they are covered by insurance.
Why is it important that contraceptive pills are more readily available?
“Reproductive justice is not just a health care issue, it’s also an economic issue and a civil rights issue,” Pressley said in a news release, noting her legislation “removes the expensive barrier to contraceptive care – affirming a person’s right to make decisions about their body, if and when to start a family, and their future.”
soon half of all pregnancies in the US are unintended ― with black and Latina women experiencing higher rates of unintended pregnancy than white women.
Some of the most common reasons why women do not use contraceptives, or experience deficiencies in contraceptive use access and costaccording 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 in pharmacies without a prescription, ACOG said.
“We know that low-income people and women of color have higher rates of unintended pregnancy and face barriers to accessing contraception ― so in my view, if a pill is available over the counter and it’s not available at an accessible price or covered by insurance… that’s not going to be a success,” Grossman said.
Finding the right pill can be difficult, due to possible side effects ― so wouldn’t having it over-the-counter, without a doctor’s visit, make it harder to find a suitable one?
Nothing is tougher than before. While finding the right birth control pill can be a long, sometimes frustrating process for people, having it over the counter doesn’t mean you don’t have to see a doctor, or consult your pharmacist, for help.
“It’s important to emphasize that making the pill available over the counter adds another option, it doesn’t take away options,” Grossman said.
He says that as a doctor who sees patients for contraception, it’s usually “a little trial and error,” and he doesn’t use any special tests to figure out what will work for patients — if they have one. side effects on one pill, they try another. He also noted that initially only one or two pills are likely to be available over the counter, so when someone tries it, if they experience adverse effects, they can talk to a clinician or pharmacist to see what else more options available.
If the pill were over the counter, wouldn’t that mean that people ― generally women ― wouldn’t go as often to get gynecological exams and get cancer screenings or STD tests?
“I think it’s very paternalistic that we’re holding birth control hostage and forcing people to go in and get services that are important but unrelated to contraception — like forcing them to get a Pap smear or get tested 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 this or they can’t get another unrelated treatment,” Grossman added.
Screening for cervical cancer or sexually transmitted diseases is “not medically necessary” to provide hormonal contraception, ACOG said. And such screenings “should not be used as barriers to access” to birth control, the group said.
Do other countries allow people to take birth control without a doctor’s prescription?
Like many issues when it comes to reproductive justice, the US lags behind other countries.
For contraceptive pills, people in the US, Canada and most of Europe still need a doctor’s prescription to get them. But in dozens of other countriespeople are easy get them without a prescriptionamong Portugal, India, China and Mexico.
“I think it’s time to catch up,” Grossman said.
