December 12, 2012
Women’s Health Physicians Recommend Oral Contraceptives Become OTCWashington, D.C.—No need to make space yet on the shelves near the aspirin and antacids, but the American College of Obstetricians and Gynecologists (ACOG) is recommending that oral contraceptives (OCs) be made available over-the-counter to improve access to contraception.
In a new committee opinion, the women’s health group said that contraceptive users are capable of self-screening for contraindications. It did raise questions, however, about the role of pharmacists, how pharmacists would be paid for their services and whether insurers would even cover OTC oral contraceptives.
Responding to concerns that some women would fail to receive preventive services if they had OTC access, the authors point out that screening for cervical cancer or sexually transmitted infections is not a requirement for oral contraceptives and, therefore, shouldn't be a barrier for access.
On the plus side, they said, having the pills available OTC would allow women to purchase more than one pill pack at a time, which likely would increase the continuation rates.
“Unintended pregnancy remains a major public health problem in the United States. Access and cost issues are common reasons why women either do not use contraception or have gaps in use. A potential way to improve contraceptive access and use, and possibly decrease unintended pregnancy rates, is to allow over-the-counter access to oral contraceptives,” the ACOG panel wrote.
The report cites a 2004 national telephone survey of 811 women aged 18-44 years, which found that 68% of women at risk of unintended pregnancy would utilize pharmacy access for OCs, the contraceptive patch, the contraceptive vaginal ring, and emergency contraception. That survey also suggested that 47% of uninsured women and 40% of low-income women who were not using OCs, the contraceptive patch, or the contraceptive vaginal ring would start using those methods if they were available from pharmacies without a prescription. In another survey of 1,271 women aged 18–49 years, 60% 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.
Also cited was a national survey of 2,725 pharmacists which found that 85% were interested in providing hormonal contraception, with 66% expressing concerns about reimbursement.
In addition to reviewing self-screening for contraindications, the panel says it also looked at pharmacist provision, i.e., behind-the-counter access, of hormonal contraceptive methods. The report notes that in a Direct Access Study in Washington State, several pharmacists received specialized education in the provision of hormonal contraceptive methods and were authorized to provide hormonal contraception including OCs, the contraceptive patch, and the contraceptive vaginal ring.
“Pharmacists successfully used checklists to identify women without contraindications to OCs according to the World Health Organization’s Medical Eligibility Criteria for Contraceptive Use; blood pressure and body mass index also were measured,” the report says. “Continuation of use through 12 months was fairly high (70% of 127 women), although most women were continuing users (either currently using OCs or had used hormonal contraceptives in the past), and only 65% (127 of 195 women) completed the 12-month interview. Acceptability also was high, although most women had to pay out-of-pocket for the pharmacist evaluation because most insurance providers did not cover that service.”
The FDA would have to approve any change in status for oral contraceptives, and there is no indication when or whether that might occur.
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