Without a Prescription

Over-the-counter birth control. It’s a great idea in theory. But how do we get there?

On the first day of her first year in college, Savannah remembers feeling “extremely uneasy”—and it wasn’t just freshman jitters or homesickness.

She was headed to the student health clinic to ask for birth control, and she only had $25 in her bank account. She knew that was not nearly enough pay for both the visit and the contraception she needed.

Four hundred dollars later, Savannah was right. And she spent the next three months using her paychecks from her job at Subway to pay off the balance.

“I am absolutely tired of having to choose between buying groceries and maintaining my reproductive health,” Savannah says.

For millions like Savannah across the country, the contraceptive care benefit under the Affordable Care Act—which requires most private health plans to fully cover contraception and well-woman visits with no cost to the patient—has provided much-needed relief from this all-too-familiar dilemma.

Now women’s health advocates and federal lawmakers would like to expand access even further by making oral contraceptives available without a doctor’s prescription. Although the authority to permit over-the-counter birth control ultimately lies with the Food and Drug Administration (FDA), two different bills proposed in Congress in the past month seek to encourage this process.

Senator Patty Murray recently introduced the “Affordability Is Access Act,” which requires that insurance companies cover over-the-counter birth control pills without co-pay and with no restriction on age. The bill notes that 1 in 3 women report having struggled to afford birth control at some point in their lives.

A recent study indicated that over-the-counter birth control pills coupled with insurance coverage could decrease the rate of accidental pregnancies by 25 percent—a significant drop in a country where nearly half of all pregnancies are unplanned.

“Senator Murray’s bill is a bold move in the right direction,” says Amy Friedrich-Karnik, the Center’s interim director of federal policy and advocacy. “More than 99 percent of sexually active women have relied on birth control at some point in their lives. It is absolutely central to a woman’s ability to determine her future and manage her health. We know from research that some birth control can be provided safely without a prescription.  Any other barrier—including price tags, doctors’ schedules, and pharmacy hours—should be examined and addressed so women can get the care they need without delay.” 

Another bill, introduced by Republican Senators Cory Gardner and Kelly Ayotte, falls short in key areas. While the “Allowing Greater Access to Safe and Effective Contraception Act” would make it easier for pharmaceutical companies to apply to the FDA for certain birth control drugs to be available without prescription, it would limit over-the-counter access to women over the age of 18. It also does not include any provisions to ensure the pill remains affordable for the millions of women who currently benefit from the contraception coverage required by the ACA.

Oral contraception costs can amount to as much as $600 each year, in addition to insurance premiums—a potential deal breaker for countless women. Yet reliable, affordable birth control is particularly essential for women in precarious financial situations and for teens, where the added expense and burden of an unplanned pregnancy could be catastrophic.

The Center for Reproductive Rights has long been involved in supporting efforts to make birth control more accessible. We led a decade-long battle with the FDA to make emergency contraception available without a prescription for women of all ages.  From a Citizen Petition filed in 2001 to a suit in federal court, the battle eventually concluded when a federal judge denied the government’s request to delay the availability of emergency contraception for over-the-counter use. 

Today we are proud to support state measures such as Oregon’s new law allowing women to obtain a year’s worth of birth control at one time—as well as federal legislation to restore access to affordable health coverage and care—including birth control—for immigrants. We are also working to address the Supreme Court’s decision in the Hobby Lobby case, which allows some companies to deny their employees coverage for birth control based on their employer’s personal religious beliefs.   

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