Free the pill — and make it free

This month, HRA Pharma announced it had submitted the first-ever application to the Food and Drug Administration to turn its birth control pill, Opill, from prescription to over-the-counter (OTC) status. This would allow people to purchase this birth control brand without a doctor’s visit and prescription, much as they might buy medicine-cabinet essentials like ibuprofen and acetaminophen.

This approach makes sense, because oral contraceptives are 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. Wade. If the application is approved, the U.S. would join more than 100 other countries in legalizing OTC birth control. The concept is supported by 74% of women, as well as by The American College of Obstetricians and Gynecologists and The American Academy of Family Physicians.

A positive ruling could open the door to other brands of oral contraceptive following suit.

Unintended pregnancies in the U.S. are at an all-time low, yet they still represent nearly half of all pregnancies. Brookings estimated that every unintended pregnancy cost taxpayers $9,653 in 2011, and likely higher today. The cost of preventing pregnancy is certainly well under that number though, but as in most areas health care, the U.S. still has not invested in preventive care.

Most women of reproductive age (65%) use contraception, and more than two-thirds report that the full cost of prescription contraception is always covered by health insurance or another program. But health plans are not required to cover OTC medicines, which could shift the cost onto those using birth control pills. Therefore, the introduction of OTC versions of the pill would need to be in addition to a covered prescription option and make this medication eligible for inclusion in flexible savings accounts. Even better, it could be accompanied by an expansion of the Affordable Care Act to cover OTC birth control.

Even though 9.1 million women use birth control pills, more than 19 million women of reproductive age live in so-called contraceptive deserts with limited access to a publicly funded provider who offers contraception. And one-third of women at risk for unintended pregnancy who try to obtain a prescription for birth control report having had trouble doing so.

Not only would an OTC birth control option increase access and save time spent on travel and doctor’s appointments, especially in rural areas with few providers, but researchers also anticipate it would reduce unintended pregnancies by 7% to 25%.

There are currently more than a dozen startups — including Pandia Health, PRJKT RUBY, Choix, and Favor — offering prescriptions to birth control virtually. But most don’t accept insurance, and the required virtual medical consultation can cost between $15 and $59. If the prescription requirement is dropped, these companies are well positioned to make obtaining the pill easier and more affordable, even if it means less revenue.

Preventing unintended pregnancies has become even more important than ever following the Supreme Court’s Dobbs decision repealing of Roe v. Wade. Increasing access to birth control reduces unplanned pregnancies, so why haven’t we already invested in public health policies to support widespread availability?

It is past time to implement reasonable measures to make birth control more obtainable, convenient, and affordable — or even free — for all. That was needed before the Dobbs decision, and is even more important now.

Halle Tecco is a digital health investor, an adjunct 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 funder Rock Health.