1. Haracz, Julie Michelle BSN, RN


Sensible legislation has been introduced. It's time to pass it.


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Access to effective contraception can and should be easy. No woman should have to wait months for an appointment to see a physician, travel long distances, or pay more than she can afford to prevent an unintended pregnancy.

Figure. Julie Michel... - Click to enlarge in new window Julie Michelle Haracz, BSN, RN

On March 28, Senators Joni Ernst (R-IA) and Cory Gardner (R-CO) introduced legislation that would remove barriers to family planning by making oral contraceptives available over the counter (OTC). The pending bill will make contraceptives available without a prescription to anyone 18 years and older. This bill provides incentives to pharmaceutical companies to request approval of OTC status and requires the Food and Drug Administration (FDA) to expedite review of those requests. The bill will also repeal the provision of the Affordable Care Act (ACA) that prohibits the use of health savings accounts to purchase OTC drugs without a prescription. If the bill is enacted, the United States will join more than 100 countries in which OTC contraceptives are already available.


Proponents of the legislation predict that it will enhance accessibility and increase the number of women who use contraceptives. Foster and colleagues found that access to affordable OTC contraceptives could reduce unplanned pregnancies by as much as 25% among low-income women (Contraception, 2015).


Some opponents of expanded access to oral contraceptives question whether they can be safely dispensed without screening and supervision. The FDA has always evaluated health and safety concerns before any prescription drug is approved as an OTC product. Many drugs, such as ibuprofen and omeprazole, have been through this review process. These and other OTC products, such as aspirin and acetaminophen, raised safety concerns at least on par with those presented by contraceptives, but those concerns were fully vetted. In addition, patient assistance and counseling could be provided at the point of sale, as pharmacists are always available and NPs are seeing patients with increasing frequency at retail pharmacies. Their presence would also address concerns that have been expressed for patients having low health literacy.


Other opponents to expanded access contend that OTC availability may reduce visits to primary care providers. This is a valid concern, and women who are presently seeing a physician should continue to do so. Expanded oral contraceptive access, however, addresses the needs of women who do not regularly see a physician. Both concerns can and should be addressed.


Perhaps the most vocal opponents have characterized the legislation as a strategy to sidestep the ACA's mandated insurance for prescription contraceptives but not for OTC products. To obviate such concerns, several states have already enacted laws mandating that any insurance policy sold in that state would have to cover contraceptives sold with or without a prescription.


Motives aside, the proposed legislation would benefit women who do not have insurance or who are not able to visit a physician for a prescription, and provide expanded access, low cost, and convenience for all women, both insured and uninsured.


In subsequent bills, existing concerns could be addressed by requiring that OTC contraceptives be dispensed from behind the counter, where pharmacists and NPs can provide guidance and educational support. Furthermore, nothing dictates that the federal government must provide the sole solution to enhanced contraceptive access. Several states have already authorized pharmacists to prescribe oral contraceptives, which expands access and preserves coverage for those covered under the ACA. Legislators shouldn't turn their backs to the positive benefits of any legislation simply because it is not perfect in its entirety. It's time to make OTC contraceptives available. Nurses should be strong advocates to make this happen.