What To Know About The Potential First OTC Birth Control Pill, Opill (It's About Time)

In what will undoubtedly be a win for people with uteruses, an OTC birth control pill might be available as soon as this summer. Opill, a progestin-only birth control pill, received a unanimous vote from a board of FDA advisors last week. If the FDA moves forward and gives the official sign-off, we could be just a couple of months away from access to it. In a country where abortion bans and restrictions continue to be on the rise, being able to skip the doctor's visit for a prescription and get an OTC pill is going to become more and more paramount.

"Opill is a safe and effective birth control pill that people of all ages should be able to access without the unnecessary barrier and delay of needing a prescription and mandated visits to a provider," President and CEO of Physicians for Reproductive Health Dr. Jamila Perritt said in a statement the day the FDA board had their unanimous vote. "The people we care for are smart, savvy, and resilient. They are aware of their needs and their goals regarding decisions about if, when, and how they build their families, plan, or prevent pregnancy. Moreover, the basic human right to make decisions regarding their bodily autonomy, individual agency, and family building includes the human right to make decisions about their contraceptive method without undue pressure or the interference of medically unnecessary and harmful barriers to care."

But while this is a huge deal for those who want to make decisions for their body with regard to pregnancy, even if the FDA approves Opill, it won't be completely free of roadblocks for some. Here's what you need to know.

Although Opill has been deemed safe, especially because it's not a combination pill and is progestin-only, when it comes to any OTC drug sales, pharmaceutical companies must prove that those purchasing it are aware of possible issues. What this means is that the labels, instructions, and all potential side effects must be written in a way that everyone, no matter their reading level, is able to clearly understand everything that comes with Opill, because patients will be in charge of their own health and monitoring how their body responds to the medication. At the moment, there are some concerns that those on the younger side or those who have a lower level of reading comprehension may struggle to understand how to use Opill the way they should. Birth control is only effective when used correctly.

According to research, body weight may also play a role in the efficacy of Opill. As a 2016 study found, some emergency contraceptive options aren't as effective on obese people and there's fear that the same might be true for Opill. In the 130-page FDA Briefing Document that was posted two days after the advisory board's vote, the fact that 60% of reproductive age Americans are considered obese was one of the concerns raised. If someone is unaware of their own obesity or BMI status, obtain Opill, and it doesn't work as it should, then it defeats the purpose of such easy access and undercuts efficacy.

What's important to realize is if Opill reaches OTC status, that doesn't mean it will be accessible to everyone. Although most insurance plans cover birth control, for those that don't, it will cost between $20 and $50 for a one month's supply — not necessarily a budget-friendly amount. Then there's the possibility of pharmacists who might choose to not supply Opill. Although the Biden Administration announced last year that no pharmacist can turn away someone trying to access Plan B or any other medication that results in terminating a fetus, that doesn't mean that staunch religious people won't try to stand in the way of Opill. Some religions, Catholicism in particular, bans the use of any form of birth control. 

Also if we cut out the middleman, in this case the doctor with the prescription, people might not stay on top of their sexual health as they should. "If you give people access to over-the-counter hormonal contraception," associate clinical professor in obstetrics and gynecology at UCLA Health Aparna Sridhar tells The Cut, "they may not show up in the doctor's office for other things like pap smears, breast exams, and STI tests."

Although Opill becoming OTC will be an important step for bodily autonomy, there are still some aspects that need to be figured out — the FDA does have that 130-page report after all. But as long as those requesting Opill are educated and have an understanding of how to use it, this will be something worth celebrating. According to The American Academy of Family Physicians, over 100 countries offer OTC birth control pills. It'll be nice to finally join the party.