YOU KNOW it’s a weird political season when several Republican senatorial candidates are trumpeting their support for making oral contraceptives available without a prescription — and Planned Parenthood’s political arm is running TV attack ads against them. Obviously, the GOP is trying to deflect the Democratic charge that it is waging a “war on women,” while Democrats and their allies are determined to make it stick.
Here’s a quick reality check for those interested in the genuine policy issues. Republicans tout over-the-counter access to “the pill” as a way around the religious freedom issues created by Obamacare’s requirement that all health plans offer contraception. The logic is that if birth control pills are available without a prescription, employers who object to covering contraception on religious grounds could honor their beliefs and their female employees could still get their contraceptives.
Well, not exactly. Oral contraception is the most popular method, used by 17.1 percent of all women between 15 and 44 in 2010, according to the Alan Guttmacher Institute. But it is hardly the only method. Implants and intrauterine devices remain eligible for full coverage, and would still create tension between, say, Catholic Church-connected employers and their female employees. Meanwhile, Obamacare’s zero-out-of-pocket rule applies only to prescription drugs, so while women could get contraceptive pills over-the-counter, many would paradoxically face higher upfront costs than they do now, which is the main contention of the Planned Parenthood ads.
From a purely medical perspective, however, the case for over-the-counter sales is strong. Millions have used the pill over decades without undue negative side effects. In December 2012, the American College of Obstetricians and Gynecologists called for over-the-counter sales, noting that it could improve availability for many women, and that most patients can usually self-screen for risk factors without a doctor visit. The American Academy of Family Physicians agrees. It’s possible pills would decrease in price over-the-counter, as other previously prescription-only drugs have. That’s not to mention the savings from freeing up doctors’ time. Yes, insured women might pay more out-of-pocket; but for the uninsured, of which many remain even post-Obamacare, both access and cost could dramatically improve.
The true obstacle to over-the-counter access may be not science, or cost, but law and regulation. Specifically, the Food and Drug Administration’s procedures make it more likely to reclassify a prescription drug like the pill at the request of the manufacturer, rather than at the agency’s initiative. The oral contraceptive makers have not come forward, and aren’t likely to do so, since they’re doing fine under the status quo. For all the Republicans’ huffing and puffing, their legislative proposal, the Preserving Religious Freedom and a Woman’s Access to Contraception Act, would merely urge — not require — the FDA to study over-the-counter sales.
Over-the-counter sales of birth control pills would be no panacea for religious dilemmas posed by Obamacare. It could, however, help improve women’s access to needed health care, thus preventing the individual and social costs of unintended pregnancy — if and only if accompanied by measures to ensure affordability. To make that happen, Congress would have to adjust both Obamacare and the food and drug laws, which, in turn, would require a sustained bipartisan effort in both houses. Judging by this year’s campaign rhetoric, a serious, bipartisan approach is the last thing anyone has in mind.