Over-the-Counter Contraceptives Better than a Mandate

“The Pill” turned 50 in May of 2010.  With the advent of oral contraceptives, couples had far better contraceptive options.  Democratic supporters of Obamacare wanted to make contraceptives more affordable by mandating contraceptive coverage.  Many supporters view the mandate as a feminist issue and assume anyone who opposes it is waging a war on women. The problem is that mandated benefits are not free; they come with costs that would be more efficiently borne by individuals.

Republican Senators Kelly Ayotte (R-NH) and Cory Gardner (R-CO) also want to make birth control pills easier to afford — and more accessible.  They sponsored Senate Bill 1438, Allowing Greater Access to Safe and Effective Contraception Act. S.1438 would encourage the sale of hormonal contraceptives over the counter (OTC) without a prescription.

OTC birth control pills is an idea that’s been around for a while. Planned Parenthood is on record as supporting the idea. The American Congress of Obstetricians and Gynecologists (ACOG) has also backed the idea in the past. Oddly, men tend to favor the idea more than women. A majority of men support the proposal (both Democrats and Republicans), but only a minority of women do. [See Figure]  However, when the politics are removed from the issue most people view it favorably. Indeed, a poll by Reason found seven-in-ten of those surveyed believed it should be legal to purchase birth control pills and patches without a prescription.

OTCBCYet, when S. 1438 was announced,  Senator Ayotte and her cosponsors were attacked.  Planned Parenthood Action Fund President Cecile Richards issued a press release saying, “This bill is a sham and an insult to women.”  An idea that many would ordinarily agree with is being opposed on political grounds — merely because insurers would not be legally required to pay for contraceptives purchased over the counter.  The ACOG also opposes the bill — because it erroneously believes OTC birth control would be unaffordable without insurers paying for it.

In comparison to OTC drugs, it is prescription drugs that are expensive. According to a New York-area survey conducted in 2013, prescription birth control pills’ cash price was from $9 per month to $162 per month.  In a 2014 press release Planned Parenthood argued that OTC birth control would “…force women to go back to the days when they paid out of pocket for birth control — which can cost upwards of $600 a year (equal to nine tanks of gas in a minivan).”

This is wrong.  Drug prices falls precipitously once prescription drugs become available over the counter. Consider the case with OTC heartburn medications — most of which were originally available only by prescription.  For those with severe heartburn (called gastroesophageal reflux disease) proton pump inhibitors (PPIs) are the treatment of choice. These include such drugs as Prilosec, Nexium, Prevacid and Protonix.  Proton pump inhibitors were among the most widely-prescribed medications many years running. Prilosec was the second biggest-selling drug in 2001, with sales of $3.7 billion. PPIs were the second most popular class of drugs in 2003 with $13 billion in annual sales.

Prescription PPIs were never cheap. A decade ago the monthly cost for Nexium was almost $126 if purchased month-to-month.  Prevacid and Prilosec were similarly priced when they were sold only by prescription.  Protonix is the only PPI currently sold by prescription; the current price for prescription Protonix is more than $300 for 30 pills

In the fall of 2003 Prilosec became the first PPI to become available without a prescription.  Once it began selling over the counter, the price soon fell from $4 per capsule to 60 cents a dose. Prilosec is now available at Walmart, Target, Walgreens and Sam’s Club for $0.55 to $0.64 cents per pill. Prices for generic Prilosec (omerprazole) at Costco, Walmart and Target range from $0.38 to $0.45 cents per dose. This is roughly 90 percent less than what prescription Prilosec sold for when it was only available by prescription. There are vendors on Amazon and eBay selling bulk packages of omerprazole from India for prices that are even lower. One eBay vendor is charging only $22.45 for 600 tablets of generic omerprazole. That’s only 3.7 cents apiece — a 99 percent discount off prescription Prilosec (a 1-year supply for less than $14).  Prilosec has now been joined on pharmacy shelves by OTC Nexium and OTC Prevacid, both of which sell for about 85 percent less than when they were prescription drugs.

Heartburn drugs in an older class (called H2 receptor antagonists) were also once available only by prescription. They too became much cheaper when they were approved for sale over-the-counter. When Tagamet was approved for OTC in 1994 the monthly price quickly fell from about $83 per month to about $8 to $10 per month. Costco sells generic Zantac (ranitidine) tables 180 to a box for $16.25 ($2.71 per month if taken daily).

Making heartburn drugs available without a prescription saved consumers an average of $174 per year by reducing prescription drug costs and avoiding office visits, according to the Consumer Healthcare Products Association. It estimates that for every $1 spent on an over the counter drug consumers save $6 to $7 by avoiding higher prescription drug costs and unnecessary office visits.

S.1438 would not prevent women’s annual reproductive health wellness visits from being covered by insurance at no-cost. Neither would it remove the mandate that most health plans must cover prescription contraceptives. However, the bill would allow women to conveniently purchase hormonal contraceptives at their local drugstores or other locations without a prescription. Whereas prescription drugs are only available at 54,000 pharmacies across the nation, an additional 700,000 (nonpharmacy) retail outlets sell OTC drugs. The proposal would also allow women to use their flexible spending accounts (FSAs), health savings accounts (HSAs) and health reimbursement arrangements (HRAs) to cover the cost.

Conclusion. Allowing sales of hormonal contraceptives over the counter without a doctor’s prescription would benefit millions of men and women. Prices for prescription drugs fall by 90 percent or more within months of losing patent protection and becoming available over the counter. Oral contraceptives would likely follow the same trajectory.

Comments (4)

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  1. James R Chaillet, Jr MD says:

    Great post. The people who are against this bill aren’t thinking clearly or clearly have a political agenda. Note that ,currently, there are about 30 different oral contraceptives available via prescription(maybe more). There is nothing in the makeup of these pills or the manufacturing process that should make them, as a class, inherently expensive. When I started practice in the late 70’s, the cost to patients was about $1 per month.

    Moreover, poor people would likely continue to have the cost covered by Medicaid. Medicaid in Ohio covers over the counter medications such as allergy medications, proton pump inhibitors and H2 blockers.

    These could be concerns about appropriate use by consumers; however, these could and should be addressed by the right type of packaging and labeling and by continuing to seek advice from physicians, nurse practitioners, PAs and ,yes, Planned Parenthood.

    Furthermore, it would mean savings for those with high deductible plans – people who often have to pay out of pocket for these medications now and who often pay retail prices. They would welcome the likely plummeting in pricde

  2. John Fembup says:

    This seems roughly similar to the insurance coverage of eye exams vs. lenses & frames.

    It’s still possible to purchase vision care insurance that covers lenses & frames. But more and more medical insurance plans cover annual eye exams, leaving the purchase of lenses & frames up to the individual (or provide only a nominal, fixed-dollar payment to help pay for lenses & frames).

    The similarity is this. The reproductive health exams would still be covered 100% by insurance; medications [“lenses and frames’] would be available over the counter at the individual’s expense with the exception of certain medications that remain available only with a prescription].

    “S.1438 would not prevent women’s annual reproductive health wellness visits from being covered by insurance at no-cost. Neither would it remove the mandate that most health plans must cover prescription contraceptives. However, the bill would allow women to conveniently purchase hormonal contraceptives at their local drugstores or other locations without a prescription”

    • Kathleen Goryl says:

      As I understand the government’s case is based on the premise that it has a “compelling interest” to require employers to provide contraception (and other such) benefits. The thinking is that contraception reduces unwed pregnancy and abortion. The facts show that this premise does not hold up. In fact, contraception fuels unwed pregnancy and abortion. (Source: Professor Janet E Smith, “Contraception: Why Not” CD.)
      Our population is below replacement levels. See data from the Center for Disease Control, World Health Organization as well as Demographic Bomb talk by Steven Smoot from the World Congress on the Family in 2009.
      This is not an issue of who pays for it. The issue is should this be a required benefit at all? Getting the word out on Natural Family Planning (NFP) would be a far better and healthier alternative than contraception. The latter is associated with significant health risks.
      Why did none of the 8 government accommodations consider NFP, Health Savings Accounts without required benefit restrictions, providing the same exemption the Amish and others were given from this mandate or defined contribution as accommodations to the objecting parties?
      Can these four proposed solutions still be considered?

  3. Big Truck Joe says:

    Uhhh…whose gonna pay for my condoms? Or for that matter, a girlfriend?