A Birth Control Pill Will Soon Be Available Over the Counter. Yes, Really!

On July 13th, 2023, the Food and Drug Administration (FDA) approved Opill, a progestin-only birth control pill, for over-the-counter sale. The United States will now join over 100 countries where birth control pills are available without a prescription. Victoria Nichols, Project Director with Free the Pill, sits down to talk to us about what this approval means for birth control equity and access for those in the US.  

Currently in the United States, over the counter birth control is still not available on the shelves (but it will occur soon!). Up until that point becomes a reality, patients have had to navigate a prescription model, meaning that providers must prescribe birth control during an in-person appointment at a healthcare facility. This model has always featured barriers to access, requiring a patient to take time off work, find transportation, pay co-pays or out-of-pocket costs, and more.

Efforts to move away from the prescription model and make the birth control pill available over-the-counter have been decades in the making, featuring youth activists, medical providers, and reproductive justice advocates working in coalition. The FDA approval is a reflection and culmination of this dedicated, long-term work.  

Now that the FDA has decided that the birth control pill can be accessed over-the-counter, this softens many barriers to access. People seeking the birth control pill will not have to make an appointment with a doctor, wait months for that appointment, seek time off school and work, or worry about the costs of a doctor’s visit. It is expected the birth control pill will be available on-the-shelf in early 2024.

Links from this episode

Free the Pill on Twitter
Free the Pill on Facebook
Advocates for Youth’s Free the Pill Youth Council

Over-the-Counter Birth Control Access Clears Final Hurdle Before Approval

The evidence supports over-the-counter access to progestin-only pills: A research summary

 Advocate for Youth's report on the barriers young people face under the prescription model

 Birth Control Obstacle Course @ the White House - #FreeThePill

 State OTC contraception coverage laws

 Major medical organizations like the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American Medical Association support making birth control pills available over the counter because they are safe, effective, and beneficial to overall health and well-being.

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Transcript

Jennie: Welcome to RePROs Fight Back, a podcast on all things related to sexual and reproductive health rights and justice. [music intro]

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Hey RePROs, how's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, I am so excited for today's episode because it is, like, just a solidly good news episode. Like, we are only gonna talk about good news things and I am just so happy. It just feels like so few and far between that we are just talking about happy things and I'm really excited. I'm just, I'm really happy to do it. So, let's keep the intro light and happy, too. I, let's talk a little bit about what's been bringing me joy. I know I talked about like the- I read a lot and you know, my dad died earlier this year and so it's been just a, a rough year. And before that, like, there was just a lot going on. And so, my happy place has been reading romance books because it was, like, the, just the amount of stress I could handle, right? 'Cause like, you knew it was gonna end in a happy ending and, like, that was the level of stress I could handle, right? Like, there might be a little drama in between, but, like, it was gonna have the happy ending. And so, I've been doing that. I've been reading cozy fiction, which I did not know was something I needed. Like, cozy fantasy—what? I did not know that was something I needed in my life, and I am so happy to have found it. And again, just the level of stress I need. So, just lovely. I got a big order of things from Liberal Jane who- I just love her design work, and I just got some really adorable new prints to put on my wall and stickers. And my favorite is these little pins with a cat and books on them that says, "Ban bigotry, not books." Oh my God, I love them so much. They're so cute. So yeah, and you should definitely check out Liberal Jane if you haven't already. She has amazing stuff, and she designed some stuff for the podcast and we definitely have an opportunity for you all to get stickers and stuff with that soon. So, stay tuned. Let's see, what else has been bringing me joy recently...I just, it’s been nice to, like, I told you the last episode, it was, like, really exciting to be able to do an interview in person and that was bringing me so much joy. Next week, I have a happy hour for a friend who switched jobs, and so all of the people that I work with in coalition, a bunch of us are getting together to have a happy hour to celebrate her. And I'm so excited to do that and see everybody in person. It's just the little things they're just…there's just a lot going on right now that is just like little rays of sunshine giving me hope. And the big one is the thing we're gonna talk about today on the episode, which is the FDA approving the very first over-the-counter birth control. And we'll talk all about it in the episode. And so, let's just go right to that. I have a wonderful interview with Victoria Nichols with Free The Pill, and let's go to my interview with Victoria.

Jennie: Hi Victoria, thank you for being here today!

Victoria: Hi Jennie, it's a pleasure to join you! Thanks for having me.

Jennie: Okay, before we get started, do you wanna do a quick introduction, let people know who you are, and include your pronouns?

Victoria: Sure, happy to. I'm Victoria Nichols. I use she/her pronouns and I'm the Project Director for Free The Pill, which is a project of Ibis Reproductive Health, which is a nonprofit that focuses on research, principled partnerships, and advancing policies around the globe. My project is focused on the United States.

Jennie: I'm so excited to have you on. Like, it is not often, I feel like I get to just have, like, an unabashedly good news conversation and so, this is so exciting.

Victoria: Yes. Lots of- lots of good news last week. So yeah, excited to talk about it. And it's really great to have something positive to talk about in the repro space. We really did need this win.

Jennie: Ok. So, I guess before we get to like what happened, maybe we should just do like a little background, so the audience is, like, better familiar. So like, what does birth control access look like right now?

Victoria: Sure. So, right now because the FDA approval just came out, we are still waiting for Opill, which is the first-ever birth control pill to be approved for over-the-counter use in the United States; we're still waiting for it to be on the shelf. And so, we're not quite to the point where we have an over-the-counter pill but do expect that to come very soon. So, up to the decision and still today we are, you know, navigating a prescription model which means that in order to access birth control pills, you have to get a prescription from a provider. And generally speaking, under this prescription model, birth control pills are obtained by making an appointment with a provider, a doctor, nurse practitioner, et cetera, at a healthcare facility at their office. So, that means you have to usually take off time from school or work for that appointment. You have to have transportation to get to that appointment. You're paying the cost of that appointment. If you have insurance, you're maybe getting that covered in some way. If you don't have insurance, you're paying for that out of pocket. So, there are lots of barriers to access. I don't know about you, but usually when someone schedules an appointment, you have to- there's a wait time. It's not usually the day-of that you get that appointment. And so, there are several barriers to access currently under the prescription model. We have seen some expansions in access. For example, in some states like California and Oregon and Washington, they allow for a pharmacist to prescribe birth control pills so people in those states can access it through a pharmacy, but it still does require a prescription, so you have to engage with that pharmacist to get it. It's limited to, you know, only some states, so it's not federal. So, some people in states that don't have those policies can't access it you're, you know, restricted to the pharmacist's hours. So, there are still barriers in that model. So, we're always looking to expand access and bringing it over-the-counter is a great way to reduce those barriers and break them down.

Jennie: It's so exciting and I know this has been like a long journey to get to the decision, so maybe do you wanna touch a little bit on, like, how we got here? Like, it really- people may, some people who haven't been paying attention may think it kind of came out in nowhere, but that is not the case.

Victoria: Yes, definitely. It's important to tell the full story. And no, this did not happen overnight. Actually, Ibis Reproductive Health, the organization that I worked for which houses Free The Pill and Free The Pill Coalition actually started this work back in 2004 before the coalition was called the Oral Contraceptives over-the-counter Working Group. It has since evolved to being called the Free The Pill Coalition, but that work really started back in 2004 to build the evidence and support around this. Lots of people had questions about whether birth control pills should go over-the-counter in the United States, and so a lot of research and data was explored and built and also principle partnerships with reproductive justice partners, with young- youth activists, with providers, were established to really explore this issue, making sure that it was something that people wanted, that it was safe and effective and appropriate for over-the-counter use for people of all ages. So, that work has been building for nearly two decades. In addition to that, Ibis Reproductive Health in 2016 partnered with HRA Pharma, which is now called Perrigo to do the necessary research to get a birth control pill over-the-counter in the US. And so, that partnership was a really key part in this approval that we got last week. And there is a, you know, a rigorous FDA review process that any pharmaceutical company who wants to switch a birth control pill—or any product, really—over-the-counter has to go through. They have to complete numerous studies to test whether people can read the label, whether they can determine whether it's right for them, all those things. And also testing in kind of a mock setting, a mock OTC setting, to really demonstrate that they can take it without any guidance from a provider. So, that work took, you know, 2016 to, now, 2023—about eight years. And so, we're really excited to be at this moment. It's truly historic and this win and approval really reflects the longtime commitment of this coalition and of the pharmaceutical company in building the evidence and building the research necessary for the switch.

Jennie: It's just, it's so exciting and it's so wonderful to see all of that hard work pay off. Like I was just thinking of how excited y'all must have been when we finally got the decision as we were all waiting the summer for the, like, final approval to come through.

Victoria: Yes. Very, very much excited. And you know, I think lots of our partners have been in this work since 2004—the very early days—and, you know, to build all of this and have this incredible moment last week was tremendous.

Jennie: Ok, so the FDA decision. So, what does this mean now?

Victoria: Sure. So, you know, this means that a lot of the barriers that I spoke about before: the need to make an appointment with a doctor, you know, maybe wait months for that appointment, the transportation, the time off school and work the cost of that provider visit...all of those things are broken down with an over-the-counter pill. This over-the-counter pill we expect will be on the shelves in pharmacies, in retail settings so that people can walk up to the shelf and take it off of the shelf and not have any barriers to access. And so, this is really a victory for equity. It's a victory for public health. You know, the FDA followed the science and the recommendations of their advisory committee, which are experts that they bring together, so, it's a victory for evidence-based research. And it's, you know, it's truly a victory for everyone in the country who will be able to get birth control pills over-the-counter without the unnecessary prescription barrier. I do also wanna just note that this was a movement win. It was really led by a coalition that recognized the potential of an OTC birth control pill and were committed to making this not, you know, a typical OTC switch, but one that really prioritized reproductive justice values and the communities that face the most barriers to access. So, this, you know, if implemented correctly, which is what we're working on really now, will expand access to the people who due to systemic inequities, structural barriers, other forms of oppression in our healthcare system and society, this will benefit them. We wanna make sure that this benefits the people with the most barriers to access. So, it really, truly could be a transformational change in how we access contraception.

Jennie: It's so exciting. Like, I just think of young people trying to access care. Like, it would've been so game-changing for me when I was young to be able to just go into a pharmacy and buy birth control, and it's just amazing and I'm just so excited. And then, of course, immediately my brain also went to thinking through, like, "okay, implementation problems, what do we have to worry about?" Like, thinking through my experience of, like, sitting around being around when Plan B was first approved and like all of the hangups that had. And so, I tried to just revel in the victory, but a little bit of the like, "oh God, what next?"

Victoria: Yeah. I think a lot of us think that way. You know, I'm sure you're a problem solver you know, wanting to make sure that this rolls out smoothly. We do have a strong partnership with Advocates for Youth, which is an organization that really works in partnership with young people. They have a Free The Pill youth council, and they are one of the reasons why this got approved without any restrictions on age. They testified at the advisory committee meeting, sharing their powerful and important stories about the barriers that they face accessing contraception. And so, you know, the implementation and rollout of this we will continue to work with them and work with young people to ensure that that community has equitable access to this once it's on the shelf.

Jennie: Yeah, I just, again, thinking back like what- I grew up in rural Wisconsin, so like there wasn't, you had to travel a little ways to get a doctor. There wasn't a Planned Parenthood real close. So, like, just thinking of, like, all of these communities that this now expands access to in very significant ways.

Victoria: Exactly. Totally.

Jennie: Okay. So, we're thinking like early next year is, like, when people can expect to start to see this on the shelf?

Victoria: Yes. That's what the pharmaceutical company has shared is that you know, they're working on getting this ready and expect that it'll be on the shelf in early 2024. And so, we're really excited about that. I personally can't wait to walk to my local pharmacy and see it on the aisle, you know, next to other really important healthcare products. And so, early 2024 is what we're looking ahead for.

Jennie: Definitely a day to mark on your calendar and go and take a picture of the first birth control pill over-the-counter in your pharmacy. Like, that's so exciting.

Victoria: Yes.

Jennie: I feel like there's still a lot of- some unknowns. So, do we wanna talk a little bit about things we still don't know about how this is gonna roll out or...I can think of any number of questions, but I'll let you go first and then if I still have questions, I'll ask more.

Victoria: Sure. So, one question that we've been getting a lot of questions about lately is the price. You know, of course affordability impacts access, it impacts people's ability to take care of their own health and wellbeing. And so, Free The Pill has always advocated for over-the-counter birth control pills that are priced affordably, covered by insurance, and accessible to people of all ages. And so, we are waiting to hear an announcement about the price from the pharmaceutical company and know that that is a really key piece to ensuring equitable access. And then, the other piece is around insurance coverage. So, under the Affordable Care Act, also known as the ACA, most private insurance plans must cover FDA approved methods for contraception without cost-sharing, which means without any out-of-pocket costs. Currently, some OTC methods like emergency contraception may be covered but insurance companies can require prescription for coverage and that prescription requirement for an OTC product really creates an unnecessary barrier to care. And so, we really want to make sure that any future over-the-counter birth control pill—Opill, the one that's coming over-the-counter, as well as other over-the-counter birth control options—are fully covered by insurance without a prescription. By public and private plans. And so, that is something that we believe that the administration could support with through the Affordable Care Act. There's lots of administrative opportunities for that. And then there's also rules that members of Congress can play to ensure that this is fully covered by insurance. And so, affordability—both the affordable price and insurance coverage are two key issues that will impact access and are two things that we're continuing to explore and advocate for.

Jennie: Yeah, that was definitely two of the big things I was really thinking about. And yeah, like it would just, again, I know some of the hurdles of trying to get that like over-the-counter coverage has been complicated through the years of the Affordable Care Act. So, it will be great to see if they can work this out to make sure that we can make it affordable or with no cost-sharing because that's so important to access something that is really needed.

Victoria: There are states- I think there are eight states that do have OTC coverage laws within their state, which is amazing, and we're also learning from them about, you know, the opportunities to implement over-the-counter coverage and how to really take their learnings to inform federal policy. So, you know, also learning from the states that have paved the way for equitable access and have policies that we can really look to as examples to move this forward. So, you know, just wanna give a shout out to state advocates that made coverage policies possible in those states. And, you know, look forward to, both at the state and federal level, for us to continue to advance coverage to support equitable access.

Jennie: Yeah. Again, it's just so exciting to think through all of the ways that this is gonna change lives. Like, it's just such an important development and it has now opened the door for like other birth control pills to see about getting over-the-counter approval. Like now, I feel like that first one has happened, I like to think that it would be, in theory, easier to maybe get some more approved.

Victoria: We hope so. You know, lots of- we work with medical associations, and we know that the data shows that all birth control pills are safe and effective. And so, the way that the FDA process works is it's one formulation at a time. The progestin-only pill is, you know, the first ever, and we certainly hope it's not the last.

Jennie: I think, like, the next thing I was starting to think through is, like, all of the small battles that may still be ahead—again, thinking back through Plan B and the struggles once it was supposed to be OTC and then having to fight with specific stores or chains that weren't making it as available as they should. I don't know that I have, like, a great, like, lessons-learned from that experience, but I'm sure people are starting to think through, like, what that- those fights that could be ahead between that and just whatever state-level fuckery states get up to.

Victoria: Yeah, this is another question that we get often, and I'll say that over-the-counter birth control pills does have bipartisan support. A lot of people are surprised by that, but overwhelmingly the vast majority of people support this so that is something to keep in mind. You know, we do want to be, like, prepared for anything but I do think it's pretty incredible that across the aisle a lot of people do support this. And so, we think all policymakers should really understand that over-the-counter birth control pills are an important part of healthcare. They're an important part of reproductive healthcare and the full spectrum of services that people need. And that it's really important for policymakers to support affordability, to support insurance coverage and support access to people of all ages. And this is an equity issue and something that you know, their constituents support, broadly support this. So, you know, that's usually my response to questions about, you know, uncertainty about any sort of opposition.

Jennie: It's so exciting to hear that there's bipartisan support for it.

Victoria: Yeah.

Jennie: It feels so rare these days for there to be bipartisan support for anything in our area. So, it's very exciting and I, yeah, I cannot wait for people to get access. And it should be bipartisan, right? Like access to basic healthcare that is accessible and affordable shouldn't be controversial.

Victoria: Right, exactly.

Jennie: Okay, so, we always like to wrap up by focusing on is there anything- what can our audience do right now to spread the word? Or are there things that need to happen? Are there any actions our audience should be taking?

Victoria: Sure. So I think, you know, there's a range of actions and ways to engage. One is to stay up to date on what Free The Pill is doing. We do have a place on our website, which we can share the link to, for people to sign up to get email updates. You can also follow us on social media. Free The Pill is on Twitter, Instagram, and Facebook. And so, that's a great way of, you know, staying engaged and also being able to share content with your network to educate them. We also, you know, encourage folks, if you're able to, to donate to support the next phase of our work which will really be focused on insurance coverage and affordability and also making sure that everyone...everyone's everyone knows about this so that people—no matter what your background or what your geographic area, whether you live in urban or rural neighborhoods—that you know that this is coming and can access it once it's on the shelf. And so, those are different ways to support, particularly for young people in your audience. I think, you know, follow Advocates for Youth. They have Free The Pill Youth Council that does amazing campaigns. And so, encourage folks to follow and support them as well. And so, yeah, I think staying tuned, supporting the work ahead and you know, follow and like, so that we can make sure that everyone knows about it.

Jennie: Oh man, that is such an important point. I was thinking through all of the policy roadblocks but making sure that people know that this is now available and accessible is also just, like, a huge roadblock. So, I am really glad you brought that up because that is gonna be really important coming down the pike.

Victoria: Definitely. You know, I think- we're thinking a lot about consumer education, consumer empowerment—you know, how do we make sure that people who want and need this can access it? And the first step I think is making sure people know about it. If you don't know, you don't know. So-

Jennie: Yeah.

Victoria: So yeah, spreading the word. Help us spread the word, help us make sure that everyone knows that this should be coming to a shelf near you in early 2024. And I love the idea that you said in the beginning—taking a photo with the product on the shelf is a cool way to spread the word. Advocates for Youth has done some campaigns around that, and I imagine that there will be more to come. So, sign up, stay informed, and we'll definitely keep folks posted about any next steps.

Jennie: Well, Victoria, it was lovely talking to you. Thank you so much for being here today.

Victoria: Thank you so much. It was really fun to talk to you and appreciate you covering this issue. Yeah, Free The Pill!

Jennie: Ok y'all. I hope you enjoyed my conversation with Victoria. It was wonderful to talk to her about this amazing win: the very first over-the-counter birth control. And I will see you all in two weeks! [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!