The surprise announcement from the American College of Obstetricians and Gynecologists could help bolster efforts by public health officials to make the pill more widely available. Proponents of making the pill available over the counter argue that oral contraceptives are some of the safest and most effective drugs on the market but political pressures make accessing them far too difficult. For example, most doctors prescribe the pill for one year and require women to receive a full pelvic exam before renewing that prescription despite the fact that research has shown annual Pap smears are unnecessary and can lead to false positives and expensive follow-up testing. Add in the fact that insurance companies often only dole out pills one month at a time and its easy to see the savings associated by putting the pill on the shelves.
Eradicating institutional inefficiencies is one motivator behind the announcement. Another is the fact that half the nation’s pregnancies each year are unintended, causing significant strain on the public health system. “It’s unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem,” Dr. Kavita Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International told The Huffington Post.
In order for such a reality to exist, a company would first have to be granted permission by the government and it’s unclear at this time if any are considering it. And there is the issue of cost. Obamacare requires FDA-approved contraceptives to be available without co-pays for women enrolled in most employer-provided workplace insurance plans. If the pill were sold without a prescription, it wouldn’t be covered under that provision. ACOG addressed this issue, noting that on average, uninsured women pay $16 per month’s supply.
This may not be the fight the Obama administration was looking for, but they may end up having it. And making the pill available over the counter and without a prescription may be just the answer to the endless litigation by religious extremists to the contraception mandate. Assuming the cost issue is worked out, I can’t think of anything that would both serve critical public health needs and drive the hard right bonkers quite like the pill available right next to the aspirin. Let’s do this.