Abstract
Objective
This study estimates how making oral contraceptive pills (OCPs) available without
a prescription may affect contraceptive use, unintended pregnancies and associated
contraceptive and pregnancy costs among low-income women.
Study Design
Based on published figures, we estimate two scenarios [low over-the-counter (OTC)
use and high OTC use] of the proportion of low-income women likely to switch to an
OTC pill and predict adoption of OCPs according to the out-of-pocket costs per pill
pack. We then estimate cost-savings of each scenario by comparing the total public
sector cost of providing OCPs OTC and medical care for unintended pregnancy.
Results
Twenty-one percent of low-income women at risk for unintended pregnancy are very likely
to use OCPs if they were available without a prescription. Women's use of OTC OCPs
varies widely by the out-of-pocket pill pack cost. In a scenario assuming no out-of-pocket
costs for the over-the counter pill, an additional 11–21% of low-income women will
use the pill, resulting in a 20–36% decrease in the number of women using no method
or a method less effective than the pill, and a 7–25% decrease in the number of unintended
pregnancies, depending on the level of use and any effect on contraceptive failure
rates.
Conclusions
If out-of-pocket costs for such pills are low, OTC access could have a significant
effect on use of effective contraceptives and unintended pregnancy. Public health
plans may reduce expenditures on pregnancy and contraceptive healthcare services by
covering oral contraceptives as an OTC product.
Implications
Interest in OTC access to oral contraceptives is high. Removing the prescription barrier,
particularly if pill packs are available at low or zero out-of-pocket cost, could
increase the use of effective methods of contraception and reduce unintended pregnancy
and healthcare costs for contraceptive and pregnancy care.
Keywords
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Article info
Publication history
Published online: February 27, 2015
Accepted:
January 12,
2015
Received in revised form:
November 25,
2014
Received:
September 9,
2014
Footnotes
☆Disclosure: None of the authors have a conflict of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
