Purpose of review: The aim of this review is to summarize the current evidence on the safety and effectiveness of moving oral contraceptives from prescription-only to over-the-counter (OTC) status. The review also examines women's interest in OTC access to oral contraceptives, as well as potential barriers and facilitators to an OTC switch.
Recent findings: Studies show that women can safely self-screen for contraindications to oral contraceptives – especially progestin-only pills – without the aid of a clinician. One study in Texas found that women using pills obtained OTC in Mexico were significantly less likely to discontinue compared to women obtaining pills at US clinics by prescription. A national representative survey of US women at risk of unintended pregnancy found widespread interest in using OTC pills, and many women worldwide already have access to pills without a prescription. On average, the most US women report being willing to pay for an OTC pill is $20.
Summary: OTC access to oral contraceptives could help to reduce unintended pregnancy by increasing the number of pill users, improve continuation and reduce gaps in use. It is critical that a future OTC pill be made available at an accessible price, and it should be covered by insurance without a prescription. Research suggests that common concerns about the safety of oral contraceptives OTC and a potential negative effect on women's use of preventive services are largely unsupported.