The following excerpt is from an op-ed that first appeared in The Messenger on August 19, 2023.

A 24-year-old patient has come to see me for her annual OB-GYN visit. She proffers an array of snacks to her toddler son while she fills me in about wanting emergency contraception in case she needs it. Based on her medical history, I believe the most effective oral option would be ella, sometimes called the “morning-after pill,” which would dramatically reduce her chances of getting pregnant if she takes it within five days of having unprotected sex. I confirm her preferred pharmacy and send over a prescription.

Later that day, I learned that the patient couldn’t fill the script because her pharmacy doesn’t stock the medication. Neither do the other pharmacies near her home. She asks me if I know of a pharmacy in the city that has the contraceptive and I don’t — an answer that frustrates both of us. Yet, surely this isn’t the only instance of this happening; studies have found that many U.S. pharmacies may not have ella on hand.

Now comes Opill, the nation’s first over-the-counter contraceptive pill approved by the Food and Drug Administration (FDA). It sounds like a game-changer because anyone will be able to walk into a pharmacy and buy it without a prescription. But I wonder if people will experience the same missing-in-action frustration when Opill is set to hit the shelves in 2024. Will they go to their drugstore in an emergency only to discover that Opill isn’t there?  

Perrigo, the maker of Opill, acquired ella in 2022. Like ella, Opill is considered safe by the FDA. It contains the hormone norgestrel, the same substance as in prescription-only progestin pills, which are prescribed for birth control. It could become the most effective over-the-counter contraception available.

But the pill’s usefulness will depend on whether people can afford it, which pharmacies stock it and whether it gets sold behind the counter or not. Unless the federal government intervenes, the state you live in will determine whether Opill is covered by insurance after a clinician prescribes it. Currently, only 13 states require insurance companies to cover the cost of over-the-counter methods of contraception, and in 2024, only Maryland, New Jersey, New Mexico, New York and California will require plans to cover some of these methods without a prescription. If it’s not covered by insurance, the buyers of Opill will bear the cost. With barriers in getting other emergency contraceptives, will Opill be any easier to obtain?

Read the entire op-ed here.


Alice Abernathy, MD

Fellow, National Clinician Scholars Program, Perelman School of Medicine

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