Affordability is key for birth control pill

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Many medications have made the move from prescription-only to over the counter.

It's about time that the birth control pill joined the list that already includes allergy and heartburn medications, topical antifungals and a smoking cessation aid.

It's been 63 years since the U.S. Food and Drug Administration (FDA) approved the first oral contraceptive. The passing decades have demonstrated birth control pills' safety and effectiveness. Currently, more than 100 countries allow women to buy them without a prescription.

Americans deserve the same ease of access. That's why a recent move by the FDA to make one type of oral contraceptive — a medication called Opill — available without a prescription merits praise, even if its availability is long overdue in the U.S.

The historic announcement came earlier this month, marking the first time that a daily contraceptive taken orally will be available without a prescription. The new access, however, brings with it a health policy challenge that could require a federal, state or insurance industry fix to smooth out.

The challenge is affordability: Health insurance generally doesn't cover nonprescription products. Consumers instead will have to pay the full cost if they want to use Opill, which is expected to go on store shelves in early 2024. The pharmaceutical firm that makes it has not yet announced the price for a monthly package of pills.

But cost cannot be allowed to become a deterrent erasing access gains from the over-the-counter switch. Many who may benefit from buying Opill at drugstores or other retailers are those who may not be able to afford a clinic visit to get a prescription — women without health insurance or those who have inadequate insurance, for example.

Opill, a tablet taken daily, contains the hormone norgestrel, which belongs to a class of medications called progestins, the FDA notes. Pills like these are sometimes known as the "minipill" because they contain one hormone, not two. Minipills also work differently than the birth control pills that have two hormones. "The minipill thickens cervical mucus and thins the lining of the uterus. These prevent sperm from reaching the egg and a fertilized egg from implanting in the womb," according to MayoClinic.com.

It's also highly effective at preventing pregnancy, up to 98% under "perfect use conditions," according to the FDA. Contraceptives like this must be taken "at the same time each day without any breaks between monthly packs," FDA guidance states, with the agency recommending backup contraception if there's a delay of three hours or more in taking the daily tablet.

Making Opill available over the counter is an "excellent and appropriate move," said Dr. Chelsea Thibodeau, a University of Minnesota Medical School assistant professor, family medicine physician and a fellow with the Physicians for Reproductive Health advocacy group. She added that it will help eliminate barriers to contraception and empower women to decide which birth control method is right for them. Thibodeau also noted that there are few contraindications to this birth control pill's use.

The FDA advises that those with breast cancer should not use it. Those with any other type of cancer should consult with a doctor before taking it. Side effects can include spotting, menstrual irregularities or nausea, but they usually improve, Thibodeau said. Headaches can also occur but are a rarer side effect.

Insurance plans that covered oral contraceptives prior to the FDA's decision will still cover prescription-only pills. That is one option for those who have a health plan but may struggle with Opill's price. But other solutions are necessary for those who want to use Opill but don't have coverage or find its cost daunting.

One potential congressional remedy is a bill that would require private health insurance plans to cover over-the-counter birth control without any out-of-pocket costs to the policyholder. The "Affordability is Access Act" has yet to gain sufficient traction at the U.S. Capitol, but has some influential Democratic cosponsors, including Minnesota Democratic Sens. Amy Klobuchar and Tina Smith.

Insurers should also consider voluntarily taking the step outlined in the "Affordability is Access Act" regardless of congressional action. In response to an editorial writer's query, a Minnesota Council of Health Plans spokeswoman said "FDA approval is an important step and triggers the plan review process to develop a coverage policy, but many questions have to be answered."

Preventing as many unintended pregnancies as possible is a goal that should unite Americans. Making birth control more broadly available is foundational to that, which is why solutions should be explored expeditiously to prevent Opill's cost from becoming a new hurdle to those taking the responsible step of using reliable birth control.