Birth Control Pill Enters the OTC Era

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Hormonal contraception has traditionally been available only with a doctor's prescription. That is changing in both Oregon and California, where only a pharmacist's approval will be necessary. But, is this a good development?

In 1960, the hormonal contraceptive pill (birth control pill, or "The Pill") was first approved for use in the United States. This was an historic step in allowing women to control their own fertility, and was (and remains) the most effective form of birth control yet devised.

Since that time, a number of alternative methods have been invented, such as vaginal rings, IUDs, and hormonal implants and patches. Women have been required to get a prescription from their physician to buy the pills. This may be about to change, according to an account in the Wall Street Journal.

Beginning this year, both Oregon and California will allow women to purchase the pill (or hormonal patches) without a prescription. In Oregon, starting on January 1, women who are at least 18 years old will have to complete a questionnaire about their health for a pharmacist, who will then decide if the pill can be dispensed. In California, a similar rule goes into effect in March, but will not include any age restriction.

Will this be good for women? There are pros and cons both medical and financial. On the plus side, women will no longer require a visit to their doctors, which will obviously be more convenient. On the other hand, skipping the doctor visit will mean not getting a physical exam, so some conditions (such as cervical cancer and sexually-transmitted diseases) might be missed. No discussion with a pharmacist will ever replace a physical examination.

There are financial implications as well. Pharmacy benefit companies typically will pay for prescription drugs, but not over-the-counter medicines, so birth control pills will probably not be covered by insurance. So, there are tradeoffs: Convenience vs. physical exams and costs.

There are questions that will need to be answered: Will insurance cover OTC birth control? Will these changes significantly decrease gynecological exams, and, if so, will this have a negative outcome on the health of women?

All we can say right now is that "the proof of the pudding will be on the eating."