David R. Henderson  

Update on OTC Contraceptives

Postrel on Progress... Why So Little Exploitation of ...

In February, I wrote:

Nevertheless, there is a way that the federal government now cuts access to contraceptives in a way that substantially raises the cost. Were the government to get rid of the regulation that does this, women's access to contraceptives would rise and the cost would fall.

What is the regulation? It's the one that requires contraceptive pills to be prescription drugs. If, instead, drug companies were allowed to sell contraceptives over the counter, access would rise and cost would fall.

Since then there have been a number of pieces making the same point.

Virginia Postrel lays it out well here.

And now blogger Timothy Taylor, aka The Conversable Economist, makes the case here.

Could this be a case such as the ones Wayne A. Leighton and Edward J. Lopez talk about in their new book, Madmen, Intellectuals, and Academic Scribblers, in which the moment is ripe for change?

Comments and Sharing

COMMENTS (17 to date)
RPLong writes:

This is a great point, and one that I have read about a great deal over the last few months (basically, since the Democratic National Convention). I support such a measure, as do many people of all political stripes and affiliations. The only frustrating aspect of it is this:

I'm type 1 diabetic and require a prescription to purchase life-sustaining insulin. I wish some of the people who see birth control as a "women's issue" would become equally as passionate about the SAME issue as it pertains to MY body and MY medications.

In the grand scheme of things, I see access to insulin being WAY MORE important than access to the BCP, and I don't think I'm being too self-centered in saying so. You could make the same case for epi-pens and a variety of other life-saving meds. I wish the debate centered more around those medications and less around products that have viable, already-prescription-free alternatives.

KLO writes:

I agree that birth control pills should be available over the counter. From an individual patient's perspective this may or may not raise the out of pocket cost of birth control, given that insurance does not compenstate individuals for OTC drugs. Nevertheless, overall costs will be lower, which should also bring total costs down for the individual patient in the long run.

If one is committed to the position that dangerous drugs should be prescription-only, I would argue that insulin, a very dangerous drug, should remain prescription-only. Insulin is frequently abused by body builders and athletes despite the fact that it is very hard to dose properly. Too much or too little can easily be fatal. I would also argue that diabetics are much more likely to benefit from regular contact with a doctor than are otherwise healthy women seeking birth control. Insulin as an OTC product has a trickier cost/benefit analysis than does birth control.

Ken B writes:

In Ontario now pharmacists can renew almost any prescription, and nurses can prescribe almost anything. So we progress.

IMO it's the guys using insulin to body build not RPLong who should see a doctor.

egd writes:

I generally favor eliminating doctors as gatekeepers to any medication or substance. If someone wants to use oxycodone, hydrocodone, or any other drug, I don't see how it is any concern of mine.

But we all know that's not going to happen.

If the purpose of the medical profession is to serve as gatekeepers and prevent access to drugs that pose harm to individuals who are unaware of side effects, dosages, and other changes, then I don't think I am qualified to answer the question of whether birth control should be OTC. Nor, I suspect, is David Henderson, Virginia Postrel, Timothy Taylor, or most people without a medical degree.

I'll admit to a touch of bias. If birth control pills were over the counter my wife's physician wouldn't have monitored her use. Without that monitoring, a previously undiscovered health risk would have remained undiscovered, and likely would have been fatal.

(the pills weren't to blame, she had another condition. Apparently they make different types of BC pills, one including appropriate medication)

Dnb writes:

Agree with egd's comment. Just making it OTC is not going to solve problems I would say there would be an increase in pregnancies if it was made OTC because people wouldn't know how to take it correctly. BC isn't Tylenol it's not like all BCs are the same. I would like to hear a doctors viewpoint on why it should or shouldn't be OTC.

Blackadder writes:

Prof. Henderson,

Louisiana Governor Bobby Jindal also published an op-ed in the WSJ last week calling for allowing OTC birth control sales.

Simone Simonini writes:

The doctors have already weighed in. Surprisingly, they went against their self-interest and endorsed OTC sales:

ACOG Opinion on OTC Birth Control

MingoV writes:

OTC birth control pills are a bad idea. There are dozens of formulations and dosages, and most women will not have a clue about which to buy. Birth control pill effects vary greatly due to individual differences in metabolism of hormones. Also, metabolism of birth control pills is affected by use of other medications. These factors make OTC availability too risky.

My recommendation is to make birth control pills available without a prescription but only after consultation with a pharmacist. The exception would be women who already are taking birth control pills: they could just buy more of the same.

Silver writes:

Isn't Timothy Taylor the Conversable Economist?

Daublin writes:

Postrel makes a very good point:

"Two-thirds of blacks and slightly more than half of whites and Latinas surveyed said they chose their current, less-effective method of birth control because it didn’t require a prescription."

Consider two numbers:

1. The number of people who would have unwisely used a birth control pill except for the required doctor consultation. Note this doesn't include women who would voluntarily see a doctor anyway; it only includes those who are saved by virtue of the prescription system.

2. The number of people who are not using good birth control due to the prescription requirement.

It does not take a medical degree to see that even if #1 is a problem, prescriptions are a net loss if #2 is an even bigger problem.

David R. Henderson writes:

Correction made. Thanks.

John Thacker writes:

I don't understand the people here who think that lack of compliance is a good reason to keep it prescription only. People who won't read the directions on the package won't listen to a doctor or pharmacist either.

Besides, the evidence is pretty clear, from what I've seen. The problem with people not being able to follow directions is far, far overwhelmed from the annoyance and difficulty in scheduling an appointment. I would easily bet that the increase in access would far outweigh the smaller percentage of people who wouldn't follow directions otherwise but would if they had to got to a doctor.

How many people are really incapable of following the directions normally, yet able to schedule an appointment, and also would listen carefully when making that appointment? I just don't believe it would outweigh the ease of access.

John Thacker writes:

Regarding insulin, I thought it was over the counter in some states? I know that the HSA changes to prohibit OTC drugs specifically allowed insulin. In any case, it ought to be OTC as well; people need it.

Yes, it's hard to manage insulin, but it's really hard to manage with a doctor or not. Making it harder to get I think outweighs the doctor handholding, since the doctor can't always be there.

Mark V Anderson writes:

OF course birth control pills should be OTC. And insulin too. And every other drug. Prescription drugs are one of the ways that America keeps its citizens from being responsible for their own health. If a person has a question about using a drug or side effects, he can always ask his pharmacist.

If we ended doctors as gatekeepers, we might get 5-10% of folks abusing the drugs, but the other 90-95% would make good health decisions. This would increase health overall. Besides that letting people control their own health is just the right thing to do.

Ken B writes:

@Mark V Anderson: I'm pretty sympathetic, but we do need to acknowledge there are some classes of drugs where wide availability has serious adverse consequences in public health: anti-biotics. Anti-biotic resistance affects others so abusing them is not 'victimless'.
(full disclosure: partner works for a pharma.)

Mark V Anderson writes:

Ken --

That did not occur to me. It is correct that the over-use of anti-biotics is a public use problem that maybe does require the intervention of government (although I don't know that the current use of prescriptions has been very effective in that regard). But I will only yield in regard to anti-biotics. No other medicine should be regulated.

Tex Doc writes:

The flow of drugs from rx to otc over the past twenty years has in fact picked most of the low hanging fruit for safe or at least relatively trivial usage.
The problem from the physician's side is:
1. The increased number of drugs that people take, rx, otc, nutraceuticals (minimally regulated - all they have to prove is they won't kill you to market them; efficacy...not so much), creates a nearly insurmountable issue of side effects, interactions, and complications of use. Try one of the many apps for that - and you can spend all week sorting that mess out.
2. If you want patients to have logical and ordered care for their acute and chronic needs, and achieve specified health maintenance goals - is a shout out from the retail pharmacist(even the PharmD.'s) what you want? Seriously?
3. And the cynic in me, bred over twenty five years of practice, knows that Big Pharma will never put themselves even further in the gun-site of tort liability for their products - a predictable number of physicians get sued every year for failure to warn issues - OCP being a leading category - subsequent malignancies, heart disease, venous thrombembolisms. Who becomes the Big Pocket - the pharmacy chain, the Doc who didn't warn them enough to NOT but that OTC, or the multinational corporation? Or now do we all of a sudden see tort reform...

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