The future of birth control might be on your phone
Forget the trip to the doctor's office. Never mind waiting in line at your local pharmacy. Don't even worry about having to return each month for a refill. Birth control has officially entered the Internet age: You can get a prescription online and have the oral contraceptive of your choice delivered straight to your door, courtesy of the San Francisco-based company Nurx. Soon, they will be offering emergency contraception, including Plan B, too.
It goes beyond the now typical tale of click-of-a-button, there's-an-app-for-that convenience: services like this could actually revolutionize women's reproductive health and reduce the rate of unplanned pregnancies, according to experts.
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Nurx currently only serves California, which is one of dozens of states with laws allowing for telemedicine products, but has plans for expansion. The service is free with insurance—yes, even the shipping—and starts at $14 without. A patient signs up for the app, enters health and insurance information, chooses one of 31 birth control brands and then a doctor remotely reviews the request. If there are no complicating health factors, the doctor simply sends a prescription to a partner pharmacy and the pills are delivered to the patient's door. In January, Nurx will add the emergency contraception offering. Sometime next year, they plan to start providing delivery of Truvada, a highly-effective HIV prevention medication.
"I think it'll be huge to be able to facilitate access to the pill. We make oral contraceptives as difficult to continue to use as possible and then we wonder why people get pregnant," said Diana Greene Foster, director of research at Advancing New Standards in Reproductive Health, a project out of the University of California, San Francisco. "It won't end the problem of unintended pregnancy, but it will go partway there."
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That is largely thanks to solving problems of access, convenience and supply. There are other companies that offer telemedicine birth control prescriptions and insurers that provide prescription delivery, but Nurx is unusual in combining the two. Another startup, PRJKT RUBY, offers both virtual prescriptions and delivery—they even sell Ella, an emergency contraception—but they don't take insurance.
"Having to make a doctor's appointment, having to get there, getting a prescription, taking time off work, needing to get childcare, all of those things are barriers to women getting access to birth control," said Kelly Blanchard, president of the non-profit IBIS Reproductive Health. "For many of us who live in a big city or have transportation, it might not seem that hard, but if you live in a rural area or you're working more than one job or have responsibilities taking care of your kids, it's not so easy."
Lawrence Swiader, senior director of digital media at The National Campaign to Prevent Teen and Unplanned Pregnancy, agrees. "There are entire zip codes in California where there are zero clinics within an hour's drive and that's a burden if you think about people who don't have their own vehicle to drive—or even if they do and have to make multiple trips an hour each way," he said. By providing virtual prescriptions, you remove those hurdles—at least for women with Internet access.
Then there's the fact that Nurx offers three pill packs at a time, regardless of whether a woman has insurance or whether her insurance covers a bulk supply. Nurx is mum on the details of how they have managed this, calling it part of their "secret sauce," and revealing only that they "work with some great partner pharmacies and some great insurance companies."
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Research suggests that on-hand supply makes a big difference: A 2013 CDC report on contraceptive use concluded that "the more pill packs given," the more likely a woman is to continue taking the contraceptive. "Restricting the number of pill packs distributed or prescribed can result in unwanted discontinuation of the method and increased risk for pregnancy," said the paper. The reality for plenty of women is that they have to return to the pharmacy every month. A 2010 study found that 44 percent of women using oral contraceptives obtained just one pill pack at a time.
There are still kinks to be worked out in Nurx's planned emergency contraception offering. Currently, Nurx's turnaround time for delivery is 24 to 48 hours, which is a problem for a medication that should be taken as soon as possible—although in addition to Plan B, which has to be taken within three days of unprotected sex or contraception failure, it will also be offering Ella, which has a five-day window. The company says it has partnerships in the works that would allow for two-hour delivery in major cities, although it won't yet reveal the delivery mechanism.
Megan Kavanaugh, a senior research scientist at the Guttmacher Institute, pointed to cases in which pharmacists have tried to deny women emergency contraception and suggested that there are particular advantages to this direct-to-door approach when it comes to medications like Plan B. "Getting it right through the mail without having this person trying to get in-between women and their healthcare is much more ideal," she said. "Younger women in particular tend to be a little more embarrassed trying to get anything related to birth control from a pharmacist. So it just completely takes that barrier out of the equation."
This all might seem the stuff of a utopian (or dystopian, for some people) future in which women have access to convenient on-demand reproductive services, but it's actually the direction in which things are currently trending. Telemedicine has seen a dramatic rise, with more than half of states enacting laws demanding insurance coverage of such services. (It's worth noting that telemedicine is not necessarily an unmitigated good: there are concerns about sub-standard care, as well as technological malfunctions and even hacking.) It's not just telemedicine, either. Soon, California and Oregon will let pharmacists prescribe and dispense birth control directly to women, saving them the trip to the doctor's office. Alongside those developments, there has been a push toward increasing the birth control supply that women are able to get at a time: Oregon and the District of Columbia recently passed laws requiring insurers to provide women with a year's worth of pills. Over the summer, Democrats called for the Department of Health and Human Services to require the same of all insurance companies.
So we have a general push toward easier access to prescriptions and greater supplies of pills. Companies like Nurx and PRJKT RUBY go a step further, though, delivering it straight to women. According to Nurx's founders, Hans Gangeskar and Eddie Engesaeth, this is part of a technology-led revolution that goes beyond women's reproductive services. In an email to Vocativ, the co-founders said they "believe healthcare will be significantly disrupted in the near future." They added, "This is just the beginning."
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