More US pharmacists can now prescribe birth control, and soon, some patients won’t need prescriptions at all

Access to hormonal birth control — such as birth control pills and patches — is getting major changes in 2024.

Opill, the first over-the-counter birth control pill approved in the United States, should soon be available in stores and online, according to its manufacturer, Perrigo.

“We are on track for making Opill available nationwide in Q1,” a Perrigo spokesperson wrote in an email this week, referring to the period from January through March.

And more states are enacting laws that allow patients to get prescriptions for birth control directly from pharmacists, without having to see a doctor first.

At the start of this year, state laws went into effect in Connecticut and Rhode Island, and New York has passed a law that will go into effect later this year.

As of Monday, according to data from the Guttmacher Institute, 29 states and the District of Columbia have passed laws allowing pharmacists to prescribe or provide contraception without a doctor’s prescription.

Those states are Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Massachusetts, Maine, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Mexico, New York, North Carolina, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington and West Virginia.

Legislation was signed in New Jersey, but it’s still in the regulation process, said Kimya Forouzan, principal state policy associate at the Guttmacher Institute, a nonprofit that has been tracking state laws and policies on pharmacist-prescribed contraceptives.

How pharmacists can prescribe birth control

Although some states expanded contraception access after the 2022 Dobbs decision — in which the US Supreme Court overturned Roe v. Wade — states have been allowing pharmacists to prescribe birth control since 2016. Oregon was the first to pass such a law, which went into effect in January 2016, and a law in California shortly followed, “separated by a few months,” Forouzan said.

Among states, policies can look drastically different; 18 allow access for patients of all ages, but some have restrictions around minors requesting pharmacist-prescribed contraception, Forouzan said.

Some states also might have different training requirements for pharmacists before they can provide hormonal birth control, and a pharmacist may opt out of that training.

“There’s a lot of training that pharmacists have to go through, typically, to be able to prescribe, among the hundreds of other responsibilities that they have, and so they may opt not to. What that means for a person who wants the prescription from their pharmacist is, they might have to call several pharmacists, or walk into several different pharmacies, to find out if it’s actually available there,” said Michelle Long, senior policy analyst of women’s health policy at the nonprofit KFF, which tracks data on the access and availability of oral birth control pills.

“Since pharmacists have all of these other responsibilities that they’re doing, they will usually charge a consultation fee for the time it takes to prescribe if they have to conduct a patient assessment and evaluation, and they might have to take a patient’s blood pressure.

“It can actually be a time-consuming process to write this prescription, so they’ll charge a fee: $30 to $50, somewhere in that range,” Long said. “And typically, while most insurance plans are going to pay for the actual birth control, they often will not pay for that consultation fee, so that comes out of the pocket of the patient.”

But overall, policies permitting pharmacists to prescribe birth control are an effort to make contraception more accessible.

“Obviously, when it comes to contraception, it’s really important for people to have continual access to certain types of contraception, such as a birth control pill, and a gap in access can lead to unintended pregnancy,” Forouzan said.

“When you’re requiring people, for example, to go get a prescription from a health care provider, there are so many things that might be blocking their timely access to that, whether that’s transportation, whether that’s not being able to get time off of work,” she said. “And we obviously want to make sure people have access to the things that they need in the ways that work for them.”

About 71% of women, ages 18 to 44, report interest in pharmacy-based contraception, according to estimates in a study by Forouzan’s colleagues at the Guttmacher Institute, published last year in the Journal of Women’s Health.

That data came from a survey of nearly 3,000 women across Arizona, New Jersey and Wisconsin, conducted between November 2019 and August 2020. Most respondents in that survey – 73% – expressed preferences for obtaining contraception through more than one source.

Over-the-counter pill expected soon

In the next few months, Opill, the first over-the-counter birth control pill approved in the United States, may also be an option for some people.

“If you think about access in general — access to contraception and anybody being able to access it whenever they need it — as a big puzzle, pharmacists prescribing is one piece of that puzzle. Availability of contraception over the counter without a prescription is another piece of that puzzle, and there are several others too, but without one of those, you don’t have this complete picture of access,” Long said.

“Neither one on its own is going to be a panacea for access, but together, they do improve access,” she said.

The US Food and Drug Administration approved Opill, a “mini-pill” that uses only the hormone progestin, for over-the-counter availability last year. The company has not disclosed how much it will cost.

“On pricing — Perrigo will provide a manufacturer suggested retail price ahead of Opill becoming available, however, pricing will be at the sole discretion of each individual retailer,” the company spokesperson wrote in the email Tuesday.

Long said that health insurance plans are not required to cover the over-the-counter medication.

“As of right now, insurance plans typically must cover contraception with a prescription, except in a handful of states. But in general, there’s no federal law that says they have to cover Opill without a prescription,” she said.

In states where pharmacists are allowed to prescribe birth control, patients might be able to get that coverage.

“How this could work with pharmacists prescribing is, a patient can go in, they can grab Opill off the shelf, they can take it back to the pharmacy counter, give the pharmacist their health insurance card, and the pharmacy can then write a prescription for it, and then it can be covered by the person’s insurance,” Long said.

“That’s kind of how those two policies could interact with each other,” she said. “Because if the person walks into their pharmacy, grabs Opill off the shelf, goes up to the self-checkout and checks out with all of their other stuff, it’s not going to be covered by insurance, because it doesn’t have that prescription attached to it.”

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