This month, the FDA has granted approval for Opill, the groundbreaking daily oral contraceptive that will soon be available over the counter in stores and online. Reproductive health advocates are praising this approval as a significant step towards helping millions of individuals prevent unintended pregnancies, which occur nearly half the time in the United States. These advocates have long argued that removing the prescription requirement for birth control pills would improve access and provide individuals with more control over their contraceptive decisions. They hope that the FDA’s approval sets a precedent for expanding access to other over-the-counter contraceptive options in the future.
For example, Cadence, a company currently seeking FDA approval, is working on a different formulation of a birth control pill that would also be available over the counter without a prescription. However, further details regarding the cost and coverage of an over-the-counter pill still need to be worked out. Here, we provide answers to common questions and concerns regarding the new pill and how it can be used with insurance.
1. Who would be interested in an over-the-counter oral contraceptive like Opill?
Anyone may be interested, depending on their circumstances. In a recent survey, over three-quarters of women of reproductive age expressed support for making birth control available over the counter as long as it is proven to be safe and effective. Uninsured individuals can save the cost of a visit to a healthcare provider and avoid the need for time off work or childcare. Even individuals with health coverage may be interested, particularly young individuals covered under their parents’ plan who may not want insurance notices sent home. Additionally, individuals whose partners are opposed to contraception may choose to bypass their insurance coverage. Convenience could also be a factor, such as when on vacation or unable to schedule a timely appointment with a primary care doctor.
2. Why choose Opill?
Opill (norgestrel) contains only one hormone, progestin, whereas most contraceptive pills on the market contain both estrogen and progestin. Progestin-only pills, often referred to as mini-pills, have very few contraindications, making them safe for a broader population. One key contraindication for Opill is a history of breast cancer. Progestin-only pills and combination pills containing both progestin and estrogen are over 90% effective during normal use.
3. When will Opill be available, and how much will it cost?
Opill is set to be available in stores and online in early 2024, but the pricing for a monthly pack of pills has yet to be disclosed. The average monthly cost for oral contraceptives ranges from $0 for those with health insurance to approximately $50. Perrigo, the company behind Opill, has stated that it will offer a consumer assistance program, allowing some individuals to receive the pill free of charge, although details are still to come.
4. Is the new pill covered by health plans?
Not necessarily. Under the Affordable Care Act’s preventive services guidelines, most health plans are required to cover FDA-approved contraceptives, including progestin-only oral contraceptive pills, without any out-of-pocket costs for members. However, this does not mean that plans must cover every single type of pill available. As there are various progestin-only pills on the market, Opill may not be the one selected by your plan. Nevertheless, if your doctor determines that Opill is the most suitable contraceptive for you, health plans must have a process in place to provide it without cost sharing, even if it is not on your plan’s list of covered drugs.
5. I have health insurance and receive my birth control pills without paying. Can I simply pick up Opill off the shelf and not pay for it?
That is the ultimate goal, according to advocates. However, initially, you will likely need a prescription from your doctor to obtain Opill without paying (assuming it is covered by your plan). Health plans can currently require a prescription for oral contraceptives, posing a barrier to the objective of easier access. Advocates argue that purchasing something off the shelf and then seeking reimbursement does not align with a “no out-of-pocket costs” approach. Recent federal guidance highlights the requirement for health plans to cover emergency contraception purchased over the counter, with or without a prescription, without cost sharing. Advocates are urging the federal government to explicitly require no-cost coverage for all over-the-counter contraceptives without a prescription. Although certain states already mandate coverage without a prescription or copayment for at least one over-the-counter contraceptive method, federal regulation is crucial to ensure consistent coverage across all health plans.
©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.
Denial of responsibility! VigourTimes is an automatic aggregator of Global media. In each content, the hyperlink to the primary source is specified. All trademarks belong to their rightful owners, and all materials to their authors. For any complaint, please reach us at – [email protected]. We will take necessary action within 24 hours.
