I am a physician, and I work for Nurx, one of several companies that allow women to access birth control over the internet. I have prescribed birth control tens of thousands of times. I have several comments about This article article published today, arguing that birth control should be over the counter. Although I agree with the broad goal of women being able to control their reproductive lives, there are some problems with the solutions proposed. I started this as a comment, and decided it was too long
1 — birth control does require some screening that is quite a bit more involved than, say, deciding if you can safely take Tylenol. The most common pills contain both a progestin and estrogen. About ¼ of the tens of thousands of patients I have prescribed for have some issue in the medical information that makes estrogen a problem. They need to either receive a progestin-only option, or they need risk counseling about the estrogen. A few have a problem with progestin. Many other medications interact with birth control pills. The screening process to safely prescribe estrogen is much more involved than can fit into the warning box on a pill pack. A web-based screening process, like the one I provide, only costs $15/year. If it saves even one women out of a thousand having a stroke or clot-related complication, it is very economical.
2 - Oregon and Calif both allow pharmacists to dispense birth control after screening. Uptake by pharmacists is poor because it is a hassle for them, and few want to do it. Having BC prescriptions written by someone whose work flow is set up to do it is better.
3 — earlier recommendations that women receive a gym exam before getting an Rx for birth control no longer apply, and haven’t for about 15 years. Even when women see a gyno for birth control, she can opt out of a gyn exam. But a blood pressure is very important. And screening for STDs is a good idea for all sexually active people regardless of their gender or need for contraception.
4 — BC pills can be as cheap as $6/pack or as much as $100+ per pack, without insurance. There is no logic to the price variation. It helps to have someone help who is savvy about the brands, savings plans, and pharmacies that will minimize the cost.
5 - If BC was otc, many insurance plans would stop covering it unless there was some specific law forcing them to. Someone else mentioned this in a comment to the original article. But it is worth emphasizing.
6 — planned Parenthood is subsidized by contributions, but it is not free to the patient. Cost is still a major barrier for many women.