Potential public sector cost-savings from over-the-counter access to oral contraceptives.
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.


METHODS
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.


CONCLUSIONS
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.
Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology & Reproductive Science, University of California, San Francisco, San Francisco, CA 94143, USA. Electronic address: fosterd@obgyn.ucsf.edu.
Diana G
DG
Foster
Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology & Reproductive Science, University of California, San Francisco, San Francisco, CA 94143, USA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143, USA.
M Antonia
MA
Biggs
UCSF Center for Translational and Policy Research in Personalized Medicine (TRANSPERS Center), Department of Clinical Pharmacy, University of California, San Francisco, CA 94143, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94143, USA.
Kathryn A
KA
Phillips
Ibis Reproductive Health, Cambridge, MA 02138, USA.
Kate
K
Grindlay
Ibis Reproductive Health, Oakland, CA 94612, USA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143, USA.
Daniel
D
Grossman
D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior; D003273:Contraceptive Devices; D003277:Contraceptives, Oral, Combined / Q000191:economics*; D017046:Cost Savings / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D004366:Nonprescription Drugs / Q000191:economics*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D017150:Public Sector / Q000191:economics*; D055815:Young Adult
D003277:Contraceptives, Oral, Combined; D004366:Nonprescription Drugs
Insurance coverage; Oral contraceptives; Over the counter; Projections