What Will Be the Cost of the First Over-the-Counter Birth Control Pill?

The enthusiasm surrounding the launch of the first over-the-counter birth control pill is tempered by a pivotal question: Will it be affordable and truly accessible to all?

Approving Opill for over-the-counter sales will expand access to contraception and reduce unintended pregnancies, especially among young people, minorities, and those who have difficulty dealing with the challenges involved in getting a prescription for their contraceptive needs. (Perrigo)

Opill, the first over-the-counter birth control pill, is set to hit drugstores, grocery stores and online shelves in the first quarter of 2024. But the real challenge lies ahead: Will it be affordable and truly accessible to all?

For years, reproductive health advocates have argued that removing the time-consuming requirement for a prescription to access birth control pills would improve accessibility and allow people greater autonomy in their contraceptive choices. 

Opill is a progestin-only oral contraceptive pill, boasting a success rate as high as 98 percent in preventing pregnancies.  The U.S. Food and Drug Administration hailed the approval of Opill as a breakthrough that could “reduce barriers to access” for those seeking contraception. 

Perrigo Company, the pharmaceutical company behind Opill, has committed to improving access to contraception in alignment with the FDA. “Perrigo is proud to lead the way in making contraception more accessible to women in the U.S.,” said Murray Kessler, president and CEO of Perrigo, in a 2023 press release. “We are motivated by the millions of people who need easy access to safe and effective contraception.”

However, the promise of accessibility hinges on the crucial factor of affordability. 

Perrigo has yet to disclose pricing details for Opill’s 28-tablet pack. Reproductive health groups and policy analysts are urging both the company and the government to ensure that Opill is financially accessible to all, especially those in underserved communities who need it most.

The Critical Need for Equity

Nearly half of all pregnancies in the United States are unintended, with a notable and disproportionate impact on Hispanic and Black women. Communities of color are susceptible to unintended pregnancies due to higher levels of poverty, limited access to quality healthcare, and barriers to education.

“Latinas often face barriers to care due to transportation, cost, language and documentation,” said Ann Marie Benitez, senior director of government relations at the National Latina Institute for Reproductive Justice

Historical injustices such as forced sterilizations and reproductive coercion have also sown deep-seated mistrust of healthcare systems among minority populations, intensifying barriers to reproductive healthcare access.

“Barriers and access to contraception do not fall equally in the same way that the impacts of the Dobbs decision do not fall equally,” Rachel Fey told Ms. She is the vice president of policy and strategic partnerships at Power to Decide, a nonprofit that works to advance sexual and reproductive well-being for all by providing trusted information, expanding access to quality services, and catalyzing culture change. “We’re talking about the same people who, because of systemic racism, are more likely to struggle to make ends meet economically, are more likely to face medical racism, and are struggling to get care with a lot more barriers than others.”

Opill has the potential to bridge these barriers in access—but only if it is accompanied by efforts to rebuild trust and ensure equitable access. 

Navigating Towards Affordable Access

For those without health insurance, there is the necessity of ensuring Opill is accessible and affordable through safety net providers such as Title X-funded clinics and community health centers. Fey said these institutions serve as vital resources for low-income individuals and those lacking health insurance. Making Opill available through these services aims to close the gap in birth control access, ensuring that everyone, regardless of economic status, has access to necessary contraceptives.

This all boils down to the issue of affordability.

The communities that currently face the highest barriers to accessing contraception are often the same communities for whom a high retail price would put Opill out of reach altogether.

Free the Pill

A 2022 KFF study shows only 16 percent of reproductive-age women would pay over $20 monthly for OTC birth control. Eleven percent are unable or unwilling to pay anything for these contraceptives.

With the average monthly cost of birth control at $18.80 for insured and $22.30 for uninsured individuals, on top of any required out-of-pocket payment to the doctor for initial consultations which average $87 annually, the monthly expense exceeds $20. If Opill’s price mirrors the average cost of birth control, only a small fraction could afford it.

Recognizing this affordability threshold, the Free the Pill steering committee has sent a public letter to Perrigo and retailers nationwide. They call for Perrigo to ensure a retail price of no more than $15 for a three-month supply of Opill and to create a comprehensive assistance program for those unable to afford this cost.

Currently, prices for one-month fills range from $22 to $79 among the most popular birth control pills. 

“Perrigo’s and retailers’ decision to price Opill affordably can help to combat contraceptive inequities—rooted in systemic racism and other forms of oppression—that already persist across the United States. As a result of these inequities, the communities that currently face the highest barriers to accessing contraception are often the same communities for whom a high retail price would put Opill out of reach altogether,” the Free the Pill steering committee wrote. 

This acknowledgment of affordable pricing as an initial measure paves the way for further discussions on accessibility.

“The first step is having Opill on the shelf at what we hope will be an affordable price for many, but with a recognition that no price will be affordable for all,” Fey said. 

The Current Healthcare Landscape

The Affordable Care Act (ACA) mandates full coverage for FDA-approved contraceptives by insurers. Yet, a significant gap exists: OTC contraceptives aren’t covered without a doctor’s prescription. This loophole essentially negates the benefit of their over-the-counter availability, forcing people to secure a prescription for insurance coverage.

Facing this coverage gap, a group of Democratic governors including California’s Gavin Newsom, is pushing the Biden administration to allow Medicare, Medicaid and other federal health plans to cover contraceptives without needing a prescription. This multi-state Reproductive Freedom Alliance, a coalition of 21 bipartisan governors focused on reproductive rights, sent a letter to the U.S. Department of Health and Human Services in Dec. 2023, urging the agency to “clarify that the ACA’s preventive health mandate includes no-cost coverage of OTC contraceptives without a prescription.”

They argue this step is crucial to prevent a fragmented approach to coverage that could leave low-income and marginalized groups at a disadvantage.

The Biden Initiative

The coalition’s efforts gained momentum as the Biden administration took action last month with an executive order aimed at addressing the requirements of the contraceptive coverage provision on plans. The order directs health plans to cover all contraceptives without a generic equivalent, and mandates a transparent exceptions process.

Despite this guidance, however, findings from Power to Decide and the House Oversight Committee have brought attention to numerous cases of insurance plans failing to adequately cover contraceptives as mandated. 

“The government must enforce these guidelines to ensure insurance plans comply, or this is just another piece of guidance,” Fey said, “and we will continue to see gaps in coverage that are violations of the ACA.”

The strict enforcement of these guidelines would help reduce the administrative barriers patients face in accessing the contraception they need, fulfilling the ACA’s goal of providing comprehensive health coverage.

These moves towards making contraceptive options more accessible represents a pivotal moment in healthcare—yet, without universal accessibility, contraceptive equity remains an unfulfilled promise. As Opill prepares for its market debut, its impact on affordability and accessibility remains a focal point of national discussion.

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Wakaba Oto is an editorial intern at Ms. and is completing her undergraduate degree in English and journalism at Fordham University. She is passionate about investigative journalism, with a focus on uncovering misconduct in government and corporate sectors. She has roots in Amsterdam and Tokyo.