• Lori Boyajian O’Neill: Support grows for OTC contraceptives

  • There are over 92 million prescriptions written annually in the U.S. for oral contraceptives. For women this represents a considerable amount of money and time spent in physicians’ offices.

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  • There are over 92 million prescriptions written annually in the U.S. for oral contraceptives. For women this represents a considerable amount of money and time spent in physicians’ offices.
    The American Congress of Obstetricians and Gynecologists seeks to change that. It has issued a recommendation that oral contraceptives be available over-the-counter, citing patient convenience and OC safety. This would be the next revolution in the history of The Pill. OC availability, what do you know, T or F?
    1. Medicaid pays for oral contraception.
    2. OCs are available OTC in some states.
    3. Pap tests are necessary for OC prescriptions.
    ACOG is the primary organization for obstetricians and gynecologists in the U.S. with membership extending worldwide to include over 50,000 physicians. The issuance of this recommendation comes at a time when the entire health-care system is being reviewed, and the news was welcomed by many women advocacy groups.
    Richard Gutknecht, M.D., an obstetrician and gynecologist at Independence Women’s Clinic, supports the ACOG proposal. He states: “Oral contraceptives are proven to be safe, and having over-the-counter oral contraceptives should improve access, be more convenient for women and may help prevent unintended pregnancies.”
    About 50 percent of all pregnancies are unintended, a primary factor which led the ACOG committee to make its recommendation. Barriers to accessing contraception have long been cited as a primary reason for non-use or sporadic use of OCs with resultant unintended pregnancies.
    Annual Pap tests and clinical examinations are typically required by physicians before OCs are prescribed but they are not medically necessary for OC use. Studies show clinic visits are a barrier for many women who desire contraception but do not have the money, time or desire to go through a clinical examination in order to get a prescription.
    ACOG cites a survey of 1,271 women ages 18-49 who showed that 60 percent of women not currently using a highly effective contraceptive method said they would be more likely to use OCs if they were available over-the-counter. The economic burden of unintended pregnancy has been estimated to cost taxpayers $11.1 billion dollars each year.
    OCs are proven very safe and effective. However, there are risks, as with all drugs. Blood clots are a primary concern, but the incidence is extremely low, with smokers, women who are pregnant and those who have just delivered at greatest risk. The World Health Organization has criteria for safe contraceptive use, which likely would be used as a guide for women and their pharmacists who could be a resource for them.
    Women may find that the purchase price for over-the-counter OCs may be higher than what they pay by prescription. OTC medications are not generally covered by insurance. There may be a shift of cost to women or there may be agreements that insurance plans would cover contraception.
    Page 2 of 2 - “We wonder what the cost would be. At this point we really don’t know,” Gutknecht said.
    Currently Medicaid does not cover the cost of contraception in Missouri, and there is no indication that that will change.
    The FDA must approve the conversion of any prescription drug to OTC. The FDA has been investigating this for a few years and, with its opinion, ACOG has lent considerable influence to an issue that will be deeply discussed in the coming months and that has significant consequences for women. Fifty-two years after The Pill was introduced in 1960, it just may become available on shelves next to aspirin and cough syrup.
    Answers: 1. F 2. F 3. F
    Dr. Lori Boyajian-O’Neill can be contacted at lori.boyajian-oneill@hcahealthcare.com.
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