July 26, 2022 

Hi CommonHealth reader,

Did you know you can get birth control bills without a prescription in dozens of countries across the world? From Latin America to Russia to the Middle East, you can simply walk into a pharmacy and purchase oral contraceptives, no doctor's note required.

This isn't the case in the U.S.; while morning-after contraceptives like Plan B are available over the counter, birth control pills remain locked behind a prescription in most states.

That could soon change.

Earlier this month, a Paris-based drug company submitted the first-ever application to the Food and Drug Administration to make oral contraception available over the counter, or "OTC." The review process is expected to take about 10 months.

This was made possible in part by nearly two decades of work by Ibis Reproductive Health, a Cambridge-based group that has been laying the groundwork and gathering data to support an FDA application.

“It’s a really exciting milestone,” Kelly Blanchard, president of Ibis, told me.

She said Ibis's data show people don’t need a doctor’s oversight to take the pill correctly and safely. And many need easier access. But according to Blanchard, pharma companies haven't considered OTC birth control a lucrative product.

“Birth control pills — it's largely a generic product market," she said. "These are not blockbuster drugs that make lots of money."

Unlike the abortion debate, this issue has not become as polarizing, nor has it always fallen along traditional political lines. Republicans like Bobby Jindal and former president Donald Trump have supported OTC access.

But one thing could become contentious: age.

In other words, should the pill be available to everyone? Or should there be an age minimum?

Blanchard — who says the data Ibis has gathered suggest younger folks are interested in using an OTC option at similar rates as adults — opposes an age restriction.

“For young people, there are a number of specific barriers around confidentiality and using their insurance for contraception, if they’re on their parents’ insurance,” she said.

An age restriction would also presumably create an ID requirement, which could exclude millions of people who don’t have IDs.

However, Andrew Beckwith, president of the Massachusetts Family Institute, opposes expanding the OTC option to minors. He argues that it's important for parents to know what medications their kids are taking so they can be watchful of side effects and potential (if rare) contraindications.

“There is a growing movement to cut parents out of their minor child's healthcare decisions, particularly in the area of sexual activity,” he wrote in an email.

In 2011, the FDA recommended making Plan B available OTC to teenagers younger than 17 — only to be unusually and controversially overruled by then-Health and Human Services Secretary Kathleen Sebelius.

So when FDA officials meet to discuss OTC birth control, we'll likely hear much more on the age debate.

Gabrielle Emanuel
Health reporter

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