There’s been some talk over the past couple years about provisions in the Affordable Care Act, commonly known as “Obamacare”, that require insurers to cover all forms of birth control without charge. Insurers can still charge thousands of dollars for chemotherapy and other procedures that save lives, but–with a very few exceptions–they can’t charge a penny for any form of birth control. Supposedly this is necessary to ensure that everyone has “access” to birth control. Of course the evidence that there was anyone having trouble accessing birth control before the law took effect was rather slim, but let’s suppose for the sake of argument that there actually are people who were having trouble getting birth control due to costs.
The odd thing is that most forms of birth control will still cost money, even though the insurers can’t charge for them. Most types of birth control pills are prescription medications. Anyone who wants to get them needs to see a doctor. Seeing a doctor costs money. (And the wonderfully named Affordable Care Act is driving up the costs of doctor visits for some people.) So if the people who are so worked up about “access to birth control” actually cared about access to birth control, one would rather expect them to deal with the fact that getting most forms of birth control means visiting a doctor and paying.
In the USA, as in most places, there are prescription medicines and there are over-the-counter medicines. Most people accept this as a matter of course and don’t think much about why it is. It seems to me that there are two reasons why we might require a prescription for a medication. First, some medicines are dangerous if used wrongly. Secondly, some medicines–antibiotics in particular–might become less effective if used too much because pathogens could develop immunity to them. Neither of these seems to apply to “the pill”, or to countless other medicines now available only by prescription.
Many people often mention the fact that the USA spends more per capita on health care than any other country, yet gets worse results than many. If we truly want to spend less, here’s a small way to chip away at costs by imitating what other countries do. First of all, reduce the list of prescription-only medicines. Keep that designation only for medicines that truly need it. In many other countries, a lot of medicines are sold over-the-counter which aren’t sold that way here. Second, in some European countries the prescribing doctor and the pharmacy aren’t separate. The same person who works in the pharmacy also has the ability to write or renew basic prescriptions, thus saving the customer a lot of trouble. The government could change these things in the USA if it wanted to.
The pill certainly can be dangerous if used incorrectly, or used by people at high risk for certain complications like blood clots/DVT, heart attack, and stroke. Taking too high a dose/too much can make a person very ill. Taking them incorrectly still exposes you to potential side effects yet render them ineffective for controlling conception.
I’m not convinced the risks are so low that we should be selling them over the counter. I’m willing to listen to arguments for and against, but right now I’m for keeping them prescription only.
I’m on board with both the specific proposal (oral contraception OTC) and the more general call (fewer prescription meds and script-writing authority for pharmacists).
Have any politicians or lobbyists been pushing this approach?
ETA: I see an article in Reason that quotes Bobby Jindal as supporting it. I wonder if he still does (the quote was from 2012). In fact now I see that the Reason article is perhaps where the OP got the notion from?
There is no MEDICAL reason why birth controls pills need to be prescription only, and there have been pushes for at least 20 years to get it OTC approved. Y’know who doesn’t want that? Generally right wing conservatives, particularly the religious ones, who want us to think of the children, or rather their teenaged daughters, who might then get contraception without their parents knowledge.
Know who else doesn’t want The Pill to be OTC? The drug companies. *Especially *now that, as you note, contraception is mandated covered by health insurance. They can sell their brand name, prescription only contraceptive pills to insurance companies for $100 a month with no cost to the end-user, while generic birth control pills go for $10 a pack. Move to OTC, and women will choose the cheaper generic pills.
<nitpick>
Birth control is only provided to women under PPACA. If her doctor writes a script for condoms because of issues with taking hormone based birth control then the insurer pays. Insurers are not required to offer her male partner insurer-paid condoms or a fully covered vasectomy.
</nitpick>
Whether it is birth control or other maintenance medications, many people are facing needing to see a doctor regularly to renew a prescription. My doctor won’t write a script to cover 12 months of my blood pressure meds because she wants to check every 6 months to see whether it is having the desired effect at the current dosage. That requires an appointment and paying for a doctor office visit to have my b/p checks - which could easily be done at a pharmacy. That would be a good candidate for a pharmacist to be able to issue a refill after a quick b/p check.
On the other hand some maintenance drugs require periodic blood testing to assist in adjusting dosages. That may require two doctor visits - one for the blood draw and a second for the results. Though a pharmacist might not be prepared to do a blood draw, the doctor could just forward the appropriate script and not require a second appointment in all cases.
Choosing which drugs could be provided OTC, which might require limited pharmacist oversight, and which remain under doctor’s prescription could turn into a real morass.
As to WhyNot’s point… IIRC it was insurers that successfully petitioned* the FDA to move certain anti-histamines and/or anti-acids to OTC. That’s not to say that third parties could successfully make such a petition for birth control… but perhaps there is an option other than waiting on BigPharma to do so.
I’m suffering from a failure to imagine how requiring a once a year visit to a doctor will help a 15 year old remember to take her medicine. Couple that with the belief that it would be easier for a 15 year old to remember to take a pill every day than to remember to use or overcome pressure not to use a condom in the heat of the moment and I think this objection fails.
If the visit is for preventative services only, the regular visit would be free as well under all the plans I’ve seen. The biggest in CA are Kaiser and Blue Cross, both have a 0 copay for those visits.