Is birth control without a prescription safe? More specifcially, is the Opill safe and affordable? The FDA, and the Free the Pill coalition, sure believe so.

Is the Opill Safe and Affordable?

Free the Pill is a coalition-driven campaign to educate and engage the public in support of over-the-counter (OTC) birth control pills in the United States. In this episode, I have a conversation with Victoria Nichols, the project director of Free the Pill.

 We discuss the Opill, which is the first-ever over-the-counter birth control pill which will be available online and on store shelves soon. 

The Free the Pill coalition is a group of more than 200 reproductive health, rights, and justice organizations, research and advocacy groups, youth activists, health care providers, prominent medical and health professional associations, and others who share a commitment to ensuring more equitable access to safe, effective, and affordable birth control to people of all ages, backgrounds, and identities in the United States.

In this conversation we discuss:

  • how the availability of the Opill would decrease barriers to birth control access
  • The cost of the Opill and what “over the counter” means for insurance coverage
  • What does the science say about the effectiveness of over the counter birth control pills
  • How did the FDA come to their decision to make Opill available? 
  • What is next for the Free The Pill coalition

Equitable access to birth control

Click here to find out if your state covers over the counter coverage! 








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00:08 – Diana Limongi (Host)
Welcome to Parenting and Politics, a podcast for parents who want to make a difference, where we look at parenting through a political lens, on Diana Limongi. Today I’m excited to welcome Victoria Nichols, the program director of Free the Pill, to discuss the OPILL, which is the first ever over-the-counter birth control pill which will be available online and in stores soon. Victoria, welcome to the podcast.

00:33 – Victoria Nichols (Guest)
Thank you so much, Diana. It’s great to be with you and really excited to talk about this breaking news.

00:40 – Diana Limongi (Host)
So I always start the podcast with a question. When I say parenting and politics, what comes to mind?

00:48 – Victoria Nichols (Guest)
Yeah, this is a great question. I’m not a parent so I don’t come from that lens, but I do think that parents play a really important role. They’re usually the voting member of the family and I think they play an important role in advancing political systems that support the health and well-being of themselves as parents, their families and also their children and the broader community that they’re in. So that’s what comes to mind when I hear parenting and politics.

01:19 – Diana Limongi (Host)
So, Victoria, I’m a huge proponent of birth control and, of course, the idea that women have a fundamental right to decide when we get pregnant, if we get pregnant, how much space between the pregnancies.

And, as someone who has taken birth control for most of my reproductive years, I remember having to go to the doctor because, like, my prescription ran out, and I remember having to pay co-pays and other hurdles, including the time that it takes to get to your doctor’s office usually wait because, for some reason, obgyns always have a very long wait and it’s not as easy as it could be. And I’ve seen things like the Affordable Care Act to reduce some of the barriers to access, like the co-pays. Before the ACA, we had to pay co-pays and now I happily pick up my prescription, my pack, without having to pay. So I’m excited to discuss the availability of this over-the-counter birth control pill and why it’s important for anyone who needs access to birth control. So tell us about why the availability of a birth control pill over the counter so no prescription is important for people that need the access.

02:41 – Victoria Nichols (Guest)
Yeah, and thank you for being a proponent of birth control. We always need birth control champions out in the world. And you bring up a lot of barriers that you experience, that many people that I’ve experienced trying to get a prescription for birth control pills. There are a lot of barriers, as you named, like scheduling the appointment with the provider, needing to wait for that appointment Usually the appointment’s not tomorrow, it’s several weeks out. Having to get transportation, especially if you don’t have a car, taking a bus or a shared ride to that appointment. And then after the appointment, you get a prescription and then you have to go to another place to pick it up. And so and we also know that these barriers fall harder on people’s color, on young people, on Indigenous folks, on people working to make ends meet because we have systemic inequities, systemic racism in our society and healthcare system.

And so important, the real win and victory here is that when this goes over the counter which it’ll be it’s checked on Monday that’s the announcement that we heard and it’ll be on shelves in the coming weeks. Having access on a shelf in your local retailer or pharmacy really eliminates a lot of those barriers that you and I are both talking about. You can go to a store, you can walk to the store, your nearby store, and pick it up off the shelf, and it’s going to be accessible to people of all ages, so people who may have additional barriers, also to people of all gender. So if you don’t identify as a woman a woman, but you have a uterus and need this product, that’s accessible to you without barriers. Or if you don’t have a uterus and want to pick it up for your partner, that’s also an option. So it really removes a lot of those barriers that we were talking about and it’s a huge victory in terms of expanding access.

04:45 – Diana Limongi (Host)
And I remembered another barrier that I didn’t talk about, but also the cost, right Like you have to pay for your doctor’s visit to get the pizza paper. And I think that I remember feeling like for me when I had to get that renewal, let refill I would call the doctor’s office and in my mind I’m like I’ve been on the same one for like years. Why is this necessary? Like just an added thing to my never-ending thing of things to think about.

05:19 – Victoria Nichols (Guest)
Exactly. And the cost of that provider visit is even higher if you don’t have insurance coverage. So you know just all all these things add up. In addition to time, it’s cost. In addition to cost, it’s convenience. It’s a lot of different things that that are being addressed all at once with this going.

05:39 – Diana Limongi (Host)
So Free the Pill is a coalition that’s been working on this for many years. Tell us a little bit about the coalition’s work for those who are not familiar.

05:47 – Victoria Nichols (Guest)
Sure. So we are celebrating this as a movement driven win, because the Free the Pill coalition has worked for so long on this. We have been mobilizing our 200 plus members who are involved in our coalition to achieve this win. The coalition was originally called the Oral Contraceptives Over the Counter Working Group and it started back in 2004. Yes, two decades ago, and we’ve been working to build the evidence, the support and the partnerships necessary to switch birth control pills over the counter in the United States.

I also want to add that it’s over the counter.

Birth control pills are over the counter in over a hundred countries, and so this coalition is like getting the United States up to speed with all the other countries around the world that are at this. The coalition started with the projessen only pill and that this is the type of pill that OPIL is and but we support, you know, all birth control pills moving over the counter and thinking about how to move other other formulations of the counter. Organizations are heavily involved in the coalition and helped ground this work and and help equity values. We also have young people involved in the coalition and on our steering committee, providers, researchers, medical associations, movement leaders all all contributing to this. They saw the potential of over the counter birth control pills and really spent, you know, the time over the past two decades to build on the research and did a lot of the advocacy work to get it over the counter. So that’s a little bit about the history. It’s a long history. It’s lots of people involved and lots of people who I’m looking for to celebrate this way.

07:30 – Diana Limongi (Host)
So I was going to ask you what you say to people who may be a little bit nervous about the fact that it is medicine. You know hormonal medicine goes into your body, that it’s available without a prescription, but you just shared that many other countries are already doing this. So what does the science say and can you share a little bit about? Are there any lessons learned? What has happened in other countries? When it’s become available?

08:03 – Victoria Nichols (Guest)
Yeah, so yes, 100 over 100 countries around the world do this already.

It’s not a new concept, it’s already happening and not a place.

But if that, you know, if that doesn’t address people’s concerns, I’d say look at the data, look at the evidence, listen to providers Birth control pills have been on the market for over 60 years.

They’re one of the best studies medications that we have on the market.

Providers medical associations like the American College of Obstetricians and Gynecologists excuse me, gynecologists the American Medical Association, the Society for Adolescence Health and Medicine all support bringing birth control pills over the counter because they are safe, effective and beneficial to people’s health and well-being.

And studies show that people can look at the back of a label and determine whether or not they they should be taking medications. We do that with a lot of over-the-counter products and and the products generally only go over the counter if they’ve been tested and studied to show that people can read the back of the label and determine whether or not they should be taking it without medical intervention. And then, in addition to that, it is important that if people have questions or they want to talk to a provider or want to get more information, that that that should be available to people in you know a lot of pharmacies the pharmacists might be able to answer questions. However, there’s no medical reason why people shouldn’t be able to access this over-the-counter progestinomy pill without a provider signing off on it, and so we have a lot of medical providers pharmacists, nurses, doctors in our coalition who are who are firm supporters of this and have advocated for this for a very long time.

Is the Opill Safe and Affordable?

09:50 – Diana Limongi (Host)
Yeah, as you were speaking, I had this image of, yeah, we go, we don’t feel well. I mean, this isn’t an instance of sickness, right, it’s an instance of taking charge and being responsible for your own reproductive choices. I had this idea of like, yes, we go to X drugstore and we’re like, oh, what do I feel? You ask where can I direct me to where this is. Or you ask the pharmacist and they tell you what they recommend, something and you read. You know, I’ve spent countless hours kind of just standing in the aisle reading the back of the thing, comparing, seeing you know what the dosage is, etc. Etc. So it really does make sense.

And now I’m kind of just shocked that it’s taken this long to get here. But it’s so exciting. It’s also very exciting that the coalition is such a strong coalition with so many different partners. I was particularly impressed with the young people who I think are leading the way in so many different fights of our time right now. And you know we say the young people, but you know these are people that are in reproductive age. Right, they should have a voice and they should definitely be part of the conversation, and I think they’re a lot savvier than I probably was at you know, 16 or 17.

11:19 – Victoria Nichols (Guest)
They’re incredible and I think another thing to mention is that they played a key role in the testimony.

There’s an FDA advisory committee meeting where they bring together two panels of experts to review the data and discuss the evidence, and there’s a moment where there’s it’s open for public testimony.

And several young people in our coalition and we have a free, the full youth council that we work with an organization called advocates for youths, which runs that in partnership with us, and they testified and they, you know, were so powerful in terms of talking about why this is necessary, why they need this, why it’s safe and effective for them, and so just a testament to the power of youth voices and the importance of listening to the people who have the most barriers to access. Young people have lots of barriers that they’re navigating through in life and in terms of accessing reproductive health care, and if you listen to young people, they bring a lot of amazing, incredible ideas to the table and also, you know they know what they’re talking about, they know that they can use this, and so they’ve been a huge part in our coalition and the leadership and just want to give them so much credit for all of their work.

12:42 – Diana Limongi (Host)
So now we already talked a little bit about how the OPIL will decrease barriers, you know, transportation, rural areas and I think also in areas where what we’re seeing is a lot of clinics and medical centers that provide reproductive care are closing, in states where, you know, abortion has been banned and rebro rights are just under attack. This pill is going to be available in the mail.

13:13 – Victoria Nichols (Guest)
Yes, it’ll be available for purchase online as well.

13:16 – Diana Limongi (Host)
So let’s talk about the costs a little bit, because that was something that when I was reading up about, I was like, oh huh, let’s talk about this to kind of clarify and then later talk about kind of what the next step is for advocating for this to be more accessible. So the OPIL will be available. It’s going to be $19.99 a month, which is a little bit over $200 a year, and that can be prohibitive to some people. You know if you’re a living, paycheck to paycheck, or if you’re a young person, you know if you don’t have a job. You know many different factors.

How can we ensure that this particular type of pill will be available and covered by insurance? Because most over the counter medication once it becomes over the counter, I think it, you know, means you have to buy it on your own. Should people be worried that that’s the trend we’re going to go into, where, instead of like the OPIL being covered by insurance, we’re going to say, well, all birth control is going to not be covered, which is not what we want. We want the OPIL to be covered by insurance.

14:25 – Victoria Nichols (Guest)
Right, yeah, exactly. So you make a really great point, and we’re you know, we’re all about equitable access, and in order for OPIL, or birth control in general, to be equitable accessible, you have to be able to afford it, right? So at the current price of $19.99 per pack this is a suggested price that the company has put out for retailers Many people will not be able to afford the product and benefit from this historic advancement in contraceptive access, and this is, you know, due to systemic inequity. Lots can really mean the difference between people getting an effective contraceptive method and going without, especially for young people, people who are working to make ends meet and communities of color and indigenous folks, due to those systemic barriers. And no one should be denied access to birth control pills due to cost. We really do need to ensure that there are affordable options for people.

Is the Opill safe?

Currently, under the Affordable Care Act, most private health plans must cover FDA approved methods of contraception, including over-the-counter products like emergency contraception and now opal. However, insurance plans can, and often do, require a prescription in order for the product to be covered, and so, if you’re thinking about the prescription environment, we’re right back to the need to get a prescription, which kind of defeats the purpose of having access over the counter. If you have to get a prescription to get it off the counter, that’s another kind of hoop that you have to jump through.

16:04 – Diana Limongi (Host)
Hold on. The morning after pill needs a prescription in order for it to be paid out by your insurance.

16:10 – Victoria Nichols (Guest)
To be covered yes, to be covered by insurance. Most plans require it. They don’t have to, they can just cover it. But most health plans will make you go get a prescription for it in order for them to cover it, and then you have to get kind of reimbursed for it. So that’s kind of a dilemma. It’s like a challenge in terms of getting insurance coverage, which makes it harder for people to get coverage for it. So it is.

This is where it gets a little tricky. Under the ACA it is covered FDA approved methods. Most health private health plans must cover it. The only challenges is that typically they require a prescription for it, and then that creates a barrier to get insurance coverage if you’re requiring a prescription for an over-the-counter problem, and this is an unnecessary barrier, right Like it’s not medically necessary for a prescription to be required. And so what we’re really advocating for is for the federal government, the Biden administration, to make it clear that insurance plans must cover over-the-counter birth control without a prescription and without a cough sharing. And so that’s something that the coalition and several allied partners have been advocating for for a long time is that birth control essential health care must be covered, even if it’s over-the-counter, without a prescription or without a cough sharing, and so that’s something that we’re continuing to work for. There are also eight states that do have laws that require coverage for over-the-counter birth control, and those states will want to also give huge shout out and credit to state advocates who’ve made that possible.

There are states that are already charging ahead and passing laws in their states for this, but we really need federal this to be a national thing, and so people in all states with insurance plans should be able to get over-the-counter birth control covered by insurance without a prescription, without a cough sharing.

18:14 – Diana Limongi (Host)
Okay, and would this be like an executive action or would be something that, like, congress would have to take action on? Because both of those things make me nervous for different reasons, one being, we don’t know, right, the next election can happen and you don’t know what’s gonna happen. So, like executive actions can be undone, right.

18:37 – Victoria Nichols (Guest)
But I also think that getting something through Congress is just really hard right now, so I wouldn’t have to be through Congress. The Biden administration could do it through administrative force, and it’s through, you know, it is through the Affordable Care Act. It’s just providing additional guidance that clarifies that this needs to be fully covered by insurance and what that means is, without a prescription, that OTC work controls is covered without a prescription cost share. So, looking for guidance from the Biden administration not we don’t necessarily need Congress to step in. However, there are things like the affordable affordability is access act that was reintroduced by Congress in May 2023. That would remove a prescription requirement for private insurance plans and ensure first control is covered by insurance without unnecessary prescription requirements. So there are things that Congress can do, but there are also things that Biden administration can do, and we urge them to do it as soon as possible, given that OTC will be on shelves very soon.

19:49 – Diana Limongi (Host)
So you mentioned there were eight states where you definitely do not need a prescription. Can you share what those eight states are so we can give them a shout out? And I crossed my fingers and hope that New York is on it.

20:01 – Victoria Nichols (Guest)
There are eight states that have laws that require coverage. They are California, illinois, maryland, new Jersey, new Mexico, new York, oregon and Washington. And I think just some additional information to add to that is that there’s different types of insurance plans. Some are state regulated, private plans, some are Medicaid and some are state employee plans. Depending on the state law it might apply to different plans. So these eight states I can say are for their state regulated plans, which are private plans, and they have laws that are covering those. When you get into Medicaid and state employee plans it’s a little bit different. So we have a fact sheet on this for on the free the pill left side and I’m happy to share it for the folks who wanna get a little bit more into the weeds about what the different laws and policies are. But those eight states, I’d say, are ahead of the game in terms of coverage.

21:05 – Diana Limongi (Host)
That’s great, and of course, no surprises there, right, those eight states.

21:10 – Victoria Nichols (Guest)
Yeah, yeah, no surprises with those eight states.

21:13 – Diana Limongi (Host)
So what is next for the free the pill coalition in terms of what you’re tackling, now that we have this historic moment where it’s going to be available?

21:27 – Victoria Nichols (Guest)
Yeah, so the work certainly does not stop here. We are really excited, so right now we’re celebrating and we’re looking ahead to what’s next. We really do wanna make sure that this is a different type of switch, and in order for it to be a different type of switch from prescription to over the counter it needs to be accessible to the people who have the most barriers, and so a lot of that has to do with making sure that it’s affordable, making sure that people know about it, making sure that they have accurate information to make informed decisions about what they wanna do, and so our next steps are really aligned. We wanna make sure that this is fully covered by insurance, without a prescription or cost sharing. We wanna make sure that people know about it. So making sure that there’s materials that lots of our partners who work directly with people in the community can share with them to have them learn more about this. Making sure that those materials aren’t Spanish, are in API languages and all the languages that folks speak around the country that’s a really important part.

Making sure that people on tribal lands can access this so really making sure that it’s available in Indian Health Service clinics that that’s a big part of our work. And then also making sure that providers know about this and know how to answer their patients’ questions. Making sure that pharmacists know about this. Questions from someone in a pharmacy don’t know how to address it, so that’s a big part of our approach and to continue to advocate for other low and no cost solutions outside of insurance coverage. The company did say that they’re gonna have a cost assistance program, so making sure that people know about that when information becomes more available. So there’s a lot of work ahead for the coalition. And then, of course, we want this to lay the groundwork for future over-the-counter switches. So we know the combined oral contraceptive is something that is potentially gonna come in the future, and then what else might be able to move over the counter and lessons learned from our process through switching the progestin only pill that we can apply to those future switches.

23:51 – Diana Limongi (Host)
That’s all super exciting and just for people that Mani clarity, the progestin only pill. Is that like similar to the mini pill, where you take it every single day?

24:05 – Victoria Nichols (Guest)
Yes, it’s a. It’s a progestin only pill, so it doesn’t have any any, as we usually don’t use the term mini pill because we just call them progestin only pills. But they are sometimes called that and yes, they’re for daily use. It’s a daily oral contraceptive. The label will recommend Taking it around the same time every day. I do do want a flag that we have done at Ibis. We have some research that I’d be happy to share that talks a little bit about the evidence behind the. We call it the three-hour window That is advised, but in general the label will say take it every day.

Actions for that to make sure that you’re taking it as as the instructions say. That’s about progestin only pills. It’s a different pill than combined oral contraceptives, and progestin only pills do not have any estrogen.

24:55 – Diana Limongi (Host)
And I think I call it the mini pill because it’s the pill they tell you to take, if you, I believe, if I’m not mistaken from what I remember my experience and you can correct me if I’m wrong it’s the pill that you can take after you have a baby and you are breastfeeding. That’s the pill that is Allowed, which is the pill that I took when I was breastfeeding my baby, which is, I think, why I call it colloquial mini bill.

25:25 – Victoria Nichols (Guest)
Yeah, and a lot of people do call it that, and and yes, it’s, it’s a pill, that is is it’s depending on what, where you are or what your conditions are. It might be a better fit for you and that is one of the things that it’s often prescribed for people who are breastfeeding, because it is the type of pill that you can take Well breastfeeding. So that is yes, but that might be why, why folks call it that. I’m not totally sure where, when, that term emerged, but it is something that people call it.

26:02 – Diana Limongi (Host)
So, Victoria, this point in the podcast after you had discussion, I have to tell you this is one of my more joyful episodes, because we’re celebrating, we’re in a celebratory mood about this thing that has happened and In the state of Reaper rights and the state of parenting and politics when, you know, the US doesn’t have paid leave and childcare, affordable childcare and all these things that parents need. This is a refreshing conversation. So thank you for joining me. I always ask this last question and I always, as I said, because we usually touch on heavier topics I always want to end on a hopeful note. So I want to ask you what keeps you hopeful in your work and in your life In this moment that we’re living in, because I think that’s what keeps us going.

26:51 – Victoria Nichols (Guest)
Yeah, this is this is definitely a positive, positive podcast topic. I’m glad that we were able to talk about something great, I’d say. What keeps me hope really has been especially through this work in this campaign has been young people who we work with, who are so incredibly brilliant in the way that they think about things and in their Kind of framework around all this, the way they think about this, the way that they’re willing to push to get what’s equitable they are. They’re really folks that we could not have had this win without the partnership. So they keep me hopeful. They also keep me excited about this work and just so grateful that we have the opportunity to work directly with them on this campaign.

27:45 – Diana Limongi (Host)
I love that, and you’re definitely not the only person who has responded the young people. So, yes, I am hopeful too when I Hear the kind of things that, like my kids might, might. I have a 13 year old boy and we were watching recently an episode of Grey’s Anatomy and it was the episode about they were rioting outside because it was a clinic where they Provide abortion care and he was like I don’t understand what, what’s happening. So I try to kind of explain it to him in terms that he would understand. He was like, oh, but Of course that people should be allowed to do what they want and of course, it should be able to go to the doctor again. You know, and I was just like I’m so proud of you, I’m so proud that you know, this is how you think.

But, yes, they definitely keep me hopeful too, and this is like a breath of fresh air. This news has been a breath of fresh air among you know the the difficult times that we are in right now In regards to women’s health and women’s reproductive health and specifically. So I want to thank you so much for joining us. Please tell people where they can check out the coalition work.

29:02 – Victoria Nichols (Guest)
Yes, free The pill dot org is our website. We’re also on Twitter X, whatever people call it, whatever people are calling it nowadays Instagram and and Facebook folks can check us out there.

We have a ton of resources on the free the pill website, especially research. Folks want to, you know, dig into some of the evidence that we talked about and we have. You know, we have a coalition arm and a campaign arm, so we’re going to be spreading the word about this. We may have activities for anyone to engage in, and so our social media and is the best way to stay tuned about that and just really appreciate, diana, the opportunity to chat with you and that you asked such great questions about this topic. Kudos to you for raising children who who already already are with this and and can speak to it. So thank you so much for your time.

30:00 – Diana Limongi (Host)
Thank you, victoria, so much for joining me and Sharing more about this great news. Everyone, thank you for listening. Um, make sure you’re following us on Instagram at parenting and politics. Also make sure to follow at free the pill, and if you have any suggestions for guests, you can send them to info at parenting and politics podcastcom.

This week I launched the shop on the podcast website. We have some mugs and we have some notebooks and we have choke bags, and during the month of march, in honor of women’s history month, we will be donating one dollar for every mug sold to repro rights organizations. The National Latina Institute for Reproductive Justice, which is part of the coalition, and also sister song women of color collective, are two organizations that I support and are nearing dear to my heart and are doing great work, especially, um, helping women of color access the reproductive care that they need. So if you want to support, check out the website or on instagram and until, oh, and Sister song is also part of the coalition. I want to want to highlight that as well. So, yes, everyone, thank you for listening and until next time. Don’t forget Hope is our superpower. Bye.