DC Bill Could Move The Pill Over the Counter

D.C. is worth moving to just for the great chili, free museums and Stephen Strasburg. Add this to this list: the potential to get a birth control prescription WITHOUT waiting six months to go see an OB-GYN. The Washington Post reports that D.C. Council member David A. Catania (I-At Large) has introduced a bill that would open the door to women being able to purchase birth control pills directly from a pharmacist, without paying to see a doctor first.

Catania told the Post,

At this point, in this city, it’s already a challenge for many women in underserved communities to get the appointments and then find a pharmacy…I think it’s a way to expand access to contraception and to conserve valuable resources.

The bill would authorize the D.C. Board of Pharmacy and Board of Medicine to create a joint protocol allowing pharmacists to provide hormonal birth control without prescriptions. It would work like a physician’s standing order, which lets public health clinics give out, for instance, antibiotics for specific diseases. Ben Young, chief of staff to Councilman Catania, emphasizes that the bill “is not actually prescribing rules”: Details like age requirements would be left to the Boards of Pharmacy and Medicine.

Young believes that the bill will pass, though anti-abortion groups still have time to kick up a fuss. Planned Parenthood has already voiced its support. If passed, then the next hurdle for OTC birth control could be Food and Drug Administration approval, though it’s not clear whether it would be within FDA jurisdiction: An FDA spokeswoman says a birth control joint protocol by the Boards would fall into a “gray area” because the FDA regulates whether drugs can be prescribed but does not tend to regulate what “the practice of medicine.” The FDA approved the “behind-the-counter” sale of Plan B in 2006 but has always maintained that birth control should be given out by doctors in order to monitor side effects and medicinal interactions.

Because the birth control would be monitored by and discussed with pharmacists, Catania argues that it would not be violating FDA standards. He said to the Post,

This is not going to be the Wild West…Pharmacists are extraordinarily overeducated for what they do on a day-in and day-out basis. There is a lot of capacity for a pharmacist to do more than they do.

A program similar to what Catania has proposed took place in Seattle in 2003-2005 and more recently in Oregon, in which the “instant birth control” program let patients apply for contraception online, then speak with doctors or nurses over the phone before receiving the medication.

What makes this bill particularly important is that it takes place in D.C., where Congress has oversight. Since the passage of the 1973 Home Rule Act, D.C. has had a local government, consisting of a 13-member city council and a mayor. However, all legislation, including the city’s budget, is subject to the approval of Congress.

Assuming that the bill passes, the track record of the current Congress suggests that Speaker of the House John Boehner will knock it off the table. Young agrees that Congressional intervention “is always a possibility.” In the past, hot topic issues like local gun control laws have come under Congressional pressure. While the bill is at least a few months away from passage and even further away from implementation, keeping it out of John Boehner’s hands should stay high on the priority list.

Photo from Flickr user brains the head under Creative Commons 2.0.


  1. eh….I think there should be at least an introductory physical with some sort of medical personnel. I mean, the pill doesn't work well for everyone. It's not recommended for women over a certain weight or women who smoke and I feel like there should be a face to face meeting so a woman (particularly a young woman) can ask questions. This could be a start to something, but I'd like to see some very careful decisions made before we go there with arms wide open.

  2. hmprescott says:

    I agree with Jennifer. Also, what will happen to the cost of pills if they go OTC? Usually the price goes up when a drug goes from prescription to OTC. Low income women get pills at reduced or no cost at Title X clinics (for now anyway) and female students can get them at student health centers. Some health insurance plans cover prescription drugs as well. If pills go OTC, they won't be covered by insurance so the cost will go from a co-pay of $5-10 to whatever the manufacturer wants to charge.

  3. While costs could be an issue, not that many low income women have access to birth control like many people assume. It's much harder for them receive a prescription. OTC forms of birth control would increase access and not necessary get rid of prescription forms. For women who have already been on the pill and have been monitored by their doctors, I don't see anything wrong with relying on an OTC version rather than having to get full physicals just to get refills.

  4. It is important to note that this is NOT truly OTC availablity. This would be pharmacists working under a standing physicians order for a prescription…..a very different thing. The screening history and blood pressure (which i assume would end up being a part of the protocol) would allow a responsible pharmacist to determine who must see a physician before receiving the pills and who should be a minimal risk. There would of course be an onus on the pharmacist to provide the same counselling to the patient about potential risks and side effects that is currently performed in a medical practice setting. And it is worth remembering that in many of the previously mentioned Title X clinics most of that counselling is currently done by medical assistants who have been trained well in counselling on contraceptive methods but have little formal education about the medications themselves. Yes cost would be a potential barrier…..but for a woman with fairly regular sexual activity paying full price for pills is not really any more expensive (per month) than currently available non prescription contraceptive methods. In a world where low income women must often wait long periods of time for a clinic visit this is an option that certainly deserves serious consideration.

  5. It’s true that cities should be a priority and high interest item and DC is a city, but the involvement of congress makes it LESS interesting, not more. What rally matters is what happens in BALTIMORE or Philadelphia or other nearby progressive cities that don’t suffer from congressional oversight. THAT is the future of contraception.
    http://tinyurl.com/townBC2 http://tinyurl.com/towncontraception http://tinyurl.com/opcensor

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