Why Not Just Provide The Pill Over The Counter? Ctd

A reader writes:

I have no problem with forms of the birth control pill being made an over-the-counter drug. Women are intelligent beings who can figure out how to use these drugs correctly, and the side effects from using birth control pills are less severe than those of other drugs currently sold over-the-counter.

That said, just selling a birth control pill over the counter wouldn’t make up for losing contraceptive coverage from health insurance. An IUD can cost upwards of $1,000 upfront for the exam and insertion. That’s a big chunk of change that many women can’t save up for. It also happens to be one of the most reliable forms of birth control because women don’t have to take a pill at the exact same time every day; once it’s in, you can largely forget about it until you want to take it out.

So pushing birth control as an OTC drug does not eliminate the need for women to have contraceptive methods covered on their health insurance.

Another speaks from personal experience to make the case “why birth control pills should not be sold overthe-counter”:

I took the pill on and off for about ten years when I was in my late teens and 20s. At first, it was prescribed by a general practitioner, and then by an elderly OB/GYN. After I married, I moved to Connecticut and needed to find a new OB. I went with the closest provider listed in my insurance booklet, which turned out to be a Planned Parenthood.

I have a history of migraine with aura.

I don’t get severe migraines as these things go, and I don’t get them frequently. Like 1/3 of migraine sufferers, however, I get weird symptoms that precede the headache – mine are visual and include flashes and zigzags of light, which is typical. According to a quick google search, 5-10% of women of childbearing age have migraine with aura, so this is hardly an exotic diagnosis.

The doctor at Planned Parenthood took the time to review my medical history. She started asking probing questions about having checked the box for “migraines” on my medical history form, which seemed bizarre to me. And then she told me she would not be renewing my prescription for the pill. While the absolute risk is still comparatively low, women who have a history of migraine with aura have a greatly increased risk of stroke if they take the combined pill (meaning the pill with both estrogen and progesterone; the vast majority of women on the pill take the combined pill).

I thought she was crazy until I went home and googled it, and she was absolutely correct. The WHO unequivocally states that women with a history of migraine with aura shouldn’t take the combined pill. Women with a history of migraine with aura can safely take progesterone-only versions of the pill, but those are less effective.

The pill is a drug. Drugs have side effects and risks. These risks are greater for some of us than others. When a drug is sold over the counter, people tend to assume the risks are minimal, and with the pill, this isn’t the case.

Update from a reader, who responds to that last paragraph:

So let’s put it behind the counter and have pharmacists dispense it. Thanks to credential creep, American pharmacists get almost as much training as doctors. Every drugstore has a licensed pharmacist but they have little practical authority to use that training. Their two main jobs are to catch doctor screw-ups and to waste your time waiting for them to check with you that yes, you have been on this medication for ten years.

Why not use the pill as a wedge to introduce the intermediate class of drugs between prescribed and OTC that most Western countries have? It’d eliminate a lot of unnecessary med-maintenance appointments with physicians, increasing capacity and lowering costs.