Liberate the birth control pill – and make it free

TThis month, HRA Pharma announced that it had filed the first-ever application with the Food and Drug Administration to upgrade its birth control pill, Opill, from prescription to over-the-counter (OTC) status. This would allow people to buy this brand of birth control without a doctor’s visit and without a prescription, much like they could buy drugstore essentials like ibuprofen and acetaminophen.

This approach makes sense because oral contraceptives are just as safe as these and other OTC drugs, and the potential for misuse or abuse is low.

This is a timely move with the repeal of Roe v. Calf. If approved, the US would join more than 100 other countries in legalizing OTC birth control. The concept has 74% of women support, as well as support from the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.


A positive verdict could open the door for other oral contraceptive brands to follow suit.

Unwanted pregnancies in the US are at an all-time low, but still account for almost half of all pregnancies. Brookings estimated that each unwanted pregnancy cost taxpayers $9,653 in 2011 and is likely higher today. The cost of birth control is certainly well below that number, but like most areas of healthcare, the US still hasn’t invested in prevention.


Most women of childbearing age (65%) use birth control, and more than two-thirds say the full cost of prescription birth control is always covered by health insurance or another program. But health plans aren’t required to cover OTC drugs, which could shift the cost to those using birth control pills. Therefore, the introduction of OTC versions of the pill would have to be in addition to a prescription option and make this drug eligible for inclusion in flexible savings accounts. Better yet, it could be accompanied by an expansion of the Affordable Care Act to cover OTC birth control.

Although 9.1 million women use birth control pills, more than 19 million women of childbearing age live in so-called contraceptive deserts with limited access to a publicly funded provider that offers contraceptives. And a third of women at risk of an unwanted pregnancy who are trying to get a contraceptive prescription report having difficulty doing so.

Not only would an OTC birth control option improve access and save time spent on travel and doctor appointments, particularly in rural areas with few providers, researchers estimate it would also reduce unwanted pregnancies by 7% to 25% .

There are currently more than a dozen startups — including Pandia Health, PRJKT RUBY, Choix, and Favor — offering birth control prescriptions virtually. However, most do not accept insurance, and the required virtual medical consultation can cost anywhere from $15 to $59. With prescription gone, these companies are well-positioned to make getting the pill easier and more affordable, even if it means less revenue.

Preventing unwanted pregnancies is a priority following the Supreme Court’s Dobbs decision overturning Roe v. Wade more important than ever. Increased access to birth control is reducing unplanned pregnancies, so why haven’t we already invested in public health policies to support widespread availability?

It’s time to take sensible action to make birth control more accessible, convenient, and affordable – or even free – for everyone. This was necessary before the Dobbs decision and is even more important now.

Halle Tecco is a digital health investor, associate professor at Columbia Business School, and host of The Heart of Healthcare Podcast. She previously founded women’s health company Natalist (acquired by Everly Health) and seed financier Rock Health.

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