Online orders begin for first over-the-counter birth control pill in the US

By Jacqueline Howard, CNN

(CNN) — The rollout is underway for Opill, the first over-the-counter birth control pill approved in the United States, and online sales began Monday morning.

Consumers can start ordering Opill online Monday, and orders will be fulfilled within a day or two, Sara Young, senior vice president and chief consumer officer at Perrigo, said in an email. So far, the product will be available at Opill.com and Amazon.

“Because privacy is important to Perrigo, Opill orders will be sent in plain, unbranded boxes,” Young wrote.

Opill has a suggested retail price of $19.99 for a one-month supply, $49.99 for a three-month supply, and at Opill.com, a six-month supply will be available for $89.99.

Earlier this month, the first shipments of Opill were sent to distributors, major drug stores and pharmacies — but as those shipments make their way through the distribution pipeline, it can take days to weeks before customers are able to get their hands on the product.

That timeline includes shipments arriving at distribution sites and then being delivered to retailers, and then the retailers either packaging the product for online orders or placing it on store shelves.

Some major retail pharmacies, such as CVS and Walgreens, have said they will offer Opill once they receive their shipments.

“Opill will be available at CVS.com and through the CVS Pharmacy app in late March,” spokesperson Matt Blanchette wrote in an email. “In early April more than 7,500 CVS Pharmacy stores will offer Opill and for added privacy and convenience, customers will be able to choose same-day delivery or buy online and pick-up in store.”

Those who will benefit the most

Online access to Opill will benefit women who live in remote rural areas or who may not have access to transportation in order to travel to stores that carry it, said Dr. Anne-Marie Amies Oelschlager, professor of obstetrics and gynecology at the University of Washington School of Medicine, who specializes in adolescent care.

“The biggest population that will benefit from this are those who have limited access to contraception in the first place. There are a lot of people in our country that live in what we would call contraceptive deserts, and these are areas where they have limited to no access to a reproductive health care provider, meaning they’d have to drive really far away to be able to access a provider, or they may not have access to a pharmacy close by,” Oelschlager said.

“In particular, this can impact adolescents who are often reliant on an adult to provide the transportation or the resources to be able to go to a provider, and this allows them to also access contraceptives with more privacy,” she said. “Similarly, people who may be in a domestic violence situation where there may be a component of contraceptive sabotage, where someone is either preventing them from using contraception or messing with their birth control, this way, they can access contraception without someone else’s knowledge.”

The more avenues through which people can access contraception – whether it’s over the counter in a store or online – the more control they can have over their reproductive health and choices, said Megan Kavanaugh, a principal research scientist at the Guttmacher Institute, a nonprofit that has been tracking the rollout of Opill.

“Having online options for people who are very tech-savvy and comfortable navigating the online environment, which we know younger people are better at anyway, is a great option,” Kavanaugh said.

“Of course, it’s also really important to have pharmacies and physical locations where other folks who need to overcome the barrier of the prescription requirements can get that over-the-counter option and maybe even interface with a pharmacist if they want to,” she said. “There’s no requirement that they need to do that, but it’s great to have as many options as available for people.”

Last year, when the US Food and Drug Administration approved Opill for use without a prescription and with no age limit, public health experts applauded the move as a milestone for the expansion of access to contraception in the United States. Now that the rollout has begun, however, there is some concern that states could place restrictions on that access.

“We live in a time when everything having to do with people’s sexual and reproductive health, and people’s ability to realize their reproductive goals and pursue reproductive freedoms, is unfortunately politicized,” Kavanaugh said.

No states have made such proposals or actions on restricting access to Opill, but the concern stems from the US Supreme Court’s Dobbs decision in 2022, which reversed Roe v. Wade and overturned the constitutional right to an abortion.

“We are concerned about access to all forms of sexual reproductive health care. So of course the Dobbs decision directly impacted abortion access, but we’ve seen evidence that it has trickled out and impacted sexual and reproductive health care, and contraceptive care,” said Kavanaugh, who testified at a FDA public hearing last year in support of approving Opill without an age restriction.

“It’s a huge milestone that Opill is available over the counter,” she said. “And I think we should really celebrate the milestone, and we should situate this milestone on this trajectory of always wanting to move towards increased access for all people.”

When considering the debate around abortion access in the United States, Oelschlager said that “if people really want to decrease unintended pregnancies – and by decreasing unintended pregnancies, decrease abortion – they should be supporting increased access to contraception.”

The possible politicization of Opill

Because the FDA approved Opill without an age restriction, people who have started menstruating and those going through perimenopause can purchase it, Dr. Leana Wen, an emergency physician and adjunct associate professor at George Washington University, said this month. In her previous role as health commissioner of Baltimore, she oversaw city-run reproductive health clinics.

“Opill should be considered by individuals who desire birth control but are unable to see a primary care physician, gynecologist or other provider who can prescribe birth control pills,” she said.

Some states may try to enforce age restrictions on Opill, Dr. Vineeta Gupta, executive director for the nonprofit the Network for Public Health Law, said in an email.

There are age restrictions on certain medications on a state-by-state basis in other contexts, such as with over-the-counter drugs containing the cough suppressant dextromethorphan, said Gupta, who wrote a blog post about this topic.

In 2012, California became the first state to prohibit the sale of cough medicines containing dextromethorphan to minors, and since then, governors from several other states have signed similar laws.

Separately, when it comes to Plan B emergency contraception, there have been some attempts to enforce state-by-state differences in age restrictions, too.

Plan B was approved for over-the-counter use for adults in 2006, and in 2013, it was approved for all ages. That year, “Oklahoma passed a law requiring anyone 17 and under to obtain a prescription before Plan B could be dispensed to them. The state was sued and the plaintiffs, represented by the Center for Reproductive Rights, prevailed. The law was held to be unconstitutional because it violated the state’s single subject rule,” Gupta said in the email. That rule prohibits individual pieces of legislation or ballot initiatives from addressing more than one issue or unrelated issues in a single law.

But these examples have not set a precedent for what type of authority states may have to restrict access to an FDA-approved medication, Gupta said.

When it comes to Opill, “many states also allow pharmacists to refuse to participate in ‘health care’ that they find morally objectionable. This could include providing individuals with Opill even though it is OTC,” she said. “Legal approval and actual access are two distinct issues, with the latter influenced by a broader set of factors including state policies, healthcare practices, and socio-economic determinants of health.”

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