Executive Summary

Just-published research finds that insurance coverage of a future over-the-counter (OTC) birth control pill would result in more widespread use by women and would be cost effective for health insurance plans.

  • Findings indicate that if the pill were fully covered by insurance, there would be an increase of 11%-21% in the number of low-income women using the birth control pill.
  • Most New Users Would Be Previous Users Of A Birth Control Method Less Effective Than The Pill Or Those Using No Method At All, Which Would Result In A Reduction Of Unintended Pregnancy By 7% To 25%.

Just-published research finds that insurance coverage of a future over-the-counter (OTC) birth control pill would result in more widespread use by women and would be cost effective for health insurance plans. Findings suggest use of an OTC birth control pill would be highest among low-income women, and would therefore have the biggest impact on unintended pregnancy, if it were fully covered by insurance.1

Researchers from the University of California, San Francisco (UCSF) and Ibis Reproductive Health in Oakland, CA, used data from published surveys on contraceptive use and women’s interest in an OTC pill to perform the analysis. Findings indicate that if the pill were fully covered by insurance, there would be an increase of 11%-21% in the number of low-income women using the birth control pill. Most new users would be previous users of a birth control method less effective than the pill or those using no method at all, which would result in a reduction of unintended pregnancy by 7%-25%, findings suggest.1

Making the pill available without a prescription has the potential to make a large impact on unintended pregnancy rates, says Diana Greene Foster, PhD, associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences and director of research of UCSF’s Advancing New Standards in Reproductive Health at the Bixby Center for Global Reproductive Health.

Birth control pills are the most commonly used reversible method of contraception in the United States,2 but it isn’t easy to obtain or consistently use the pill, notes Foster, who served as lead author of the current analysis. Among women researchers surveyed in abortion clinics, one in five reported that they had unprotected sex because they ran out of the birth control method they were using.3 A similar percentage of women who had experienced unprotected sex but never had an abortion also reported that they had had unprotected sex specifically because they had run out of birth control supplies,4 Foster observes.

“Making the pill available without a prescription would reduce these resupply problems,” Foster states. “It might also improve perceptions of the pill’s safety and also improve access for women who do not have access to a physician.”

One finding of the current study is that the impact of an OTC pill depends a lot on the price charged, says Foster. If the over-the-counter birth control pill is priced similar to OTC emergency contraception ($50 per pack), there will be very little change in pill use or pregnancy rates.1 “But if insurance plans fully cover the pill so that the out-of-pocket cost is very low, we estimate that there will be a measurable decrease in unintended pregnancy,” says Foster. “We estimate that between 11 and 21% of all women will begin to use the pill, resulting in a one-fifth to one-third drop in the number of unintended pregnancies — a very large public health impact.”

Insurance is important

Under the Affordable Care Act, most insurance plans are required to cover over-the-counter birth control methods for women, notes Daniel Grossman, MD, vice president for research at Ibis Reproductive Health. If a birth control pill becomes available OTC, women’s insurance plans will continue to cover it, notes Grossman, a co-author of the current analysis. However, an insurance company will cover only the cost of OTC drugs, including birth control, if there is a prescription for it, Grossman says.

Obtaining a prescription can be difficult for women, notes Grossman. Even if the office visit is covered, there are other time and financial costs related to an appointment, such as travel and child care. Also, women sometimes run out of pills on a weekend or when they are out of town, and they sometimes cannot get a prescription refilled, he points out.

“Requiring a prescription for coverage of an OTC pill is not only onerous, but would also negate the benefits of OTC access in the first place,” states Grossman. “To fully reap the benefits of OTC availability of the pill, it is important for women to be able to use their insurance to pay for it, whether they have a prescription or not.”

In modeling the impact of price on future OTC oral contraceptive (OC) use among low-income women, researchers found that cost matters, states Grossman. The largest numbers of women would switch to the pill from no method or a less effective method, and the largest decreases in unintended pregnancy — as much as 25% — would occur when OTC pill packs are available at low or zero out-of-pocket cost, he states.

“An OTC pill, affordably priced and covered without requiring a prescription, would make the pill more accessible to every woman, no matter what her insurance situation may be,” says Grossman. (Editor’s note: Almost 50% of participants in the 2014 CTU Contraception Survey say they support moving oral contraceptives over the counter.)

REFERENCES

  1. Foster DG, Biggs MA, Phillips KA, et al. Potential public sector cost-savings from over-the-counter access to oral contraceptives. Contraception 2015; http://dx.doi.org/10.1016/j.contraception.2015.01.010.
  2. Jones J, Mosher WD, Daniels K. Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995. Natl Health Stat Report 2012; 60:1-25.
  3. Foster DG, Higgins JA, Karasek D, et al. Attitudes toward unprotected intercourse and risk of pregnancy among women seeking abortion. Women’s Health Issues 2012; 22(2):e149-155.
  4. Biggs MA, Karasek D, Foster DG. Unprotected intercourse among women wanting to avoid pregnancy: Attitudes, behaviors, and beliefs. Women’s Health Issues 2012; 22(3):e311-318.

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