KFF Examines Challenges in Navigating Coverage for Opill, the First Over-the-Counter Daily Oral Contraceptive Pill, Coming to Market Next Year 

As Opill—the first over-the-counter daily oral contraceptive pill in the United States—is expected to be available for purchase in early 2024, new research conducted by KFF examines barriers to its accessibility for consumers and challenges in providing insurance coverage for it.

Based on interviews with nearly 80 representatives from private insurance plans, state Medicaid programs, chain pharmacies, and other key groups, the report provides a deeper view into the operational challenges in expanding access to coverage of over-the-counter contraceptive pills.

Although the new over-the-counter birth control pill could broaden access to contraceptive options across the country, KFF interviews with experts uncovered that consumers are likely to face some hurdles if they seek to have their plan cover the costs. According to the interviewees, the extent to which Opill can expand contraceptive options will depend on several factors, including clear state and federal policies and protocols, insurance coverage, pharmacy engagement, pharmacy stocking and signage, cost, and broad-scale public awareness and education.   

Perrigo, Opill’s manufacturer, has yet to announce the price of the contraceptive, which will have implications for affordability, particularly if Opill is not covered by insurance or Medicaid.

While states could require coverage of Opill in fully insured health plans, only a federal requirement would reach self-insured plans, which cover most people with employer-sponsored health coverage. A federal requirement would also apply to states that do not have existing over-the-counter contraceptive coverage requirements. Under the Affordable Care Act, health plans are generally required to cover a wide range of preventive services with no patient co-pays, including contraceptives with a prescription.

In states where over-the-counter contraceptive methods are covered without a prescription by Medicaid or private plans, consumers will generally need to get Opill at the pharmacy counter for their plan to cover it. In some private health plans, consumers may be able to pay for Opill up front and then seek reimbursement from the plan, but that could be financially and administratively burdensome for consumers and is reportedly rarely used for other over-the-counter drugs available without a prescription.

Insurance Coverage of OTC Oral Contraceptives: Lessons from Field is based on interviews conducted from January to August 2023, with nearly 80 experts and key players such as pharmacists, health plans, and state Medicaid officials involved in the coverage and provision of over-the-counter contraception in IL, NJ, NM, NY, OR, UT, and WA. States were selected based on whether they had implemented insurance coverage of over-the-counter contraception without a prescription or expanded the scope of pharmacist practice. 

Join us tomorrow, September 15th, at 12:30pm ET for a discussion of insurance coverage of over-the-counter birth control pills, which will include a presentation of the discoveries in this report.

Also, learn more about over-the-counter contraceptive pills in the brief Over-the-Counter Oral Contraceptive Pills, an overview of over-the-counter oral contraceptives and laws and policies related to insurance coverage.