The XX Factor: What women really think.

More Places To Put the Pill

Emily, thanks for the link to that meta-analysis in cautious support of over-the-counter birth control. For what it's worth, I certainly didn't mean to imply that annual cancer screenings are a waste of time. I am arguing that doctor's visits made solely for the purpose of obtaining permission to access a relatively safe form of contraception are pointlessly and harmfully burdensome. I've had to make quite a few such visits, in part because I move frequently and am incapable of getting an overworked doctor on the phone with an understaffed pharmacy. It's possible that I am overgeneralizing from my own deeply annoying experiences.

I've lived in countries where the pill is kept behind the counter and would be more than happy with such a compromise. But the FDA, unlike its counterpart agencies in England and Canada, only very rarely considers this third option due to complex regulatory barriers. (When the FDA rejected OTC status for Merck's Mevacor, for instance, several panelists said they'd be comfortable with the drug as it is sold in British pharmacies; in other words, behind the counter. They weren't given such an option, so the panel overwhelmingly voted down the application.) It's not clear that the FDA even has the authority to create a third class of drugs. But thanks in small part to Plan B, it looks like our binary classification system might be changing.

In Defense of OTC Birth Control

Emily and Torie, my grasp of the regulatory issues is imperfect, but it’s my understanding that a drug company would have to apply for over-the-counter status through the FDA. (I've never heard a single plausible medical justification for keeping birth control prescription-only.) There are various reasons why drug companies would not want to attempt this; the most obvious being that pharmaceutical companies can charge much higher prices for prescription drugs covered by insurance. Companies would also see resistance from gynecologists, who rely on their prescription powers to keep women coming back for annual appointments.

Torie, I understand your concern about insurance refusing to pay for OTC drugs, but it seems to me that your logic applies to every single drug that has gone over-the-counter, from Prilosec to Nicoderm. Keeping birth control prescription-only actually raises the cost for the poorest women—those without insurance who must pay retail at that the pharmacy counter and pay out of pocket for the doctor’s appointment required to get the prescription. When drugs go OTC the price plummets, so the cost to the consumer without insurance falls. Here's a blurb from a 2006 survey by the Pharmacy Access Partnership, a group that advocates for wider emergency contraception access:

Women said convenience, simplicity and affordability were their highest considerations when choosing their current contraceptive. Fifty-four percent of women also chose their method because it did not require a prescription. African-Americans (65%) were more likely to choose a method because it did not need a prescription, compared to Caucasians (51%) and Latinas (54%). Importantly, 20% of women said the cost of a visit to the doctor was an obstacle in obtaining a prescription contraceptive. Overall, 28% of women have had problems with obtaining a prescription for contraception, filling the prescription or getting to their supplies when they needed them. Women who had fewer resources to manage an unintended pregnancy (uninsured women, single women and younger women) were more likely to have experienced problems with obtaining a prescription for contraception.

The Trouble With OTC Birth Control

I, too, applaud the move to make Plan B available over the counter for 17-year-olds, but, Kerry, I have to raise one problem that could accompany making hormonal birth control OTC: insurance. Many insurance plans don't cover OTC medication, unless it's a special program intended to keep costs down, like providing an incentive for people to use a specific OTC heartburn medication instead of an expensive prescription drug that's not more effective. Insurance companies like the checks and balances of going through a doctor and a pharmacist before shelling out. Yaz, which you mention, costs about $60 per month retail, I believe, depending on the store, the state, etc. Planned Parenthood and other resources might step in to help, but those of us who already have high copays on birth control would feel the hit if we had to start paying full price. Considering the battles waged over getting insurance companies to pay for birth control, I can't imagine that many plans would be willing to alter their OTC policies to cover the an over-the-counter pill.

Plan B and the Bush Science Monkeys

Kerry, interesting point about making regular birth-control available without a prescription. I wonder what the medical reasons for classifying it as a prescription drug are—do you know?

In the meantime, I'm relishing Monday's Plan B decision as a rare fact-based inquiry and denouncement, by a federal judge, of the kind of monkeying around with science that we've long heard pervaded Bush agencies. Federal judges don't interfere with the decisions of federal agencies unless those decisions really, really have no legitimate basis—in legal-ese, they have to be deemed "arbitrary and capricious." This is what Judge Edward Korman concluded in his ruling kicking the Food and Drug Administration for its denial of access to Plan B (the morning-after pill that prevents pregnancy) to girls who are 17 as opposed to women 18 and older.

Because of the FDA's stubborn insistence on its arbitrary age-based distinction, the Plan B pill, which is not a prescription drug, had to be stocked behind the pharmacy counter rather than out on the shelves. And 17-year-olds, of course, weren't allowed to buy it at all. I hear you, Rachael, in wondering whether feminism is  broad enough to include women who are pro-life. But making birth control harder to get is a whole different ball game to me. I understand that Plan B falls into a tricky in-between zone because it's post-sex, but I'd like to think we could draw the line on the side that helps the girls and women who want to take it. I only wish Judge Korman's ruling had come earlier, when it would have forced the Bush FDA to get its act together.