Fifty years after the Federal Drug Administration approved a prescription birth control pill, the first over-the-counter birth control pill has become available to the public without a prescription at most pharmacies, convenience stores and grocery outlets, as well as online.
The availability of Opill, starting Monday, comes two years after the U.S. Supreme Court overturned the constitutional right to abortion under Roe vs. Wade and put a spotlight on the heated debate over birth control and a woman’s right to choose. So far, no individual states or jurisdictions have proposed restrictions on the sales of Opill, although experts say age restrictions on the sale are likely to be imposed.
Walgreens and CVS will soon carry Opill in-store as shipments arrive, but customers can already purchase the pill online at Opill.com and Amazon. Perrigo, the pharmaceutical company that sells Opill, cannot share how many purchases have already been made, but on Amazon, sales for the 24-count and 84-count supplies have already reached more than 1,700 orders over two days.
“You can avoid the necessity of consulting with a physician or getting a physical examination by a healthcare provider, and you can just order it delivered to your home and so that expands access,” said Khiara M. Bridges, a professor of law at UC Berkeley who studies reproductive rights.
Bridges said online sales of Opill will help provide access to birth control to those who live in remote or rural areas as well as victims of domestic violence. “Anytime that there is a trip involved, that’s an opportunity for a barrier to access.”
She noted that the cost could be a prohibitive barrier for low-income individuals; a 24-count box of Opill costs $20 and an 84-count box costs $50.
“Because these are not prescriptions, then the user of the medication has to bear the entire cost of it,” Bridges said. And that might reduce access for people who rely on insurance to cover their birth control medication. “This is not the final solution.”
Dr. Ashely Jeanlus, an obstetrician and gynecologist at UC San Francisco, said there might be health-related reasons her patients would chose the progestrin-only Opill over prescription contraception that contains a combination of progestrin and estrogen.
“I would never offer [medication containing estrogen] to someone who has had blood clots or strokes or … who have chronic hypertension that’s not controlled,” Jeanlus said of the increased risk for adverse side effects for these populations. She said transgender patients undergoing hormone replacement therapy might prefer to avoid medication with estrogen as well.
According to clinical trials, the pill was found to be 98% effective when taken within the same three-hour window each day. Like many other forms of contraception, there are common but mild side effects to birth control pills, the FDA stated online, such as “irregular vaginal bleeding, nausea, breast tenderness, and headaches.” The FDA warns that Opill is not for people who have had or have breast cancer.
Triona Schmelter, executive president of Perrigo, said Opill is safe for HIV-positive individuals to use, although it’s effectiveness might be reduced by HIV/AIDs medication and individuals should consult with their doctors. Progestin pills have already been available to purchase in the U.K. without prescription since 2021, and the FDA had approved norgestrel, a type of progestin, as a prescription medication in 1973. The process of approval for this pill to become commercially available in the U.S. took 50 years.
In some parts of the country, challenges to reproductive resources have mounted since the 2022 reversal of Roe vs. Wade, and Jeanlus is concerned about what it all means for the quality of patient care she can provide.
“You are limiting people’s access of choice and empowerment, and then you’re actually causing, like, havoc within the medical health system,” Jeanlus said.
Last month, in vitro fertilization services in Alabama were thrown into limbo when the state Supreme Court ruled frozen embryos were considered children before the state granted IVF immunity.
The political backlash to abortion and birth control, Bridges believes, is due to “large swathes of the population that believes strongly that sex is for procreation that should only be had inside of marriages” and don’t want young people to have casual sex. This comes as Americans as a whole are having less sex and a UCLA study showed Gen Zers were averse to seeing sex on-screen.
But Bridges said Opill could become as mundane as condoms offered for free in the restroom of a college campus. During pop star Olivia Rodrigo’s “Guts” tour, abortion rights organizations passed out emergency birth control and condoms until her team asked them to stop.
In the future, Bridges wants to see Opill accessible everywhere in public spaces. “The easier it is to get your hands on medications, the better it is for everybody,” she said. “But certainly for people who previously have not had access to reproductive health care.”
