Pharmacists Can Now Prescribe Birth Control in Oregon. Why Not Make It Over-the-Counter Everywhere?

Getting government out of the way would protect women and employers alike.


A package of birth control pills.
Bryancalabro / Wikipedia

As of last Friday, January 1, women in Oregon can skip the doctor's visit that all other states require before they're allowed to purchase birth control pills. Henceforth, pharmacists in the state can issue prescriptions for hormonal contraceptives themselves.

The change moves the state closer to the over-the-counter scheme that the American College of Obstetricians and Gynecologists endorsed in 2012. It doesn't quite go all the way, though, since technically the pills remain regulated as prescription meds.

A better solution would be to allow their sale to anyone, anywhere, without requiring a prescription at all—something Sen. Cory Gardner (R–Colo.) and a number of other Republicans proposed last year.

As my colleague Elizabeth Nolan Brown has explained, getting rid of the prescription requirement would increase women's freedom to make choices for themselves. Not everyone can afford to take time off work and pay the price of a doctor's visit just to obtain a permission slip to use a drug that's totally legal and widely regarded as safe. And while Obamacare requires contraception to be covered at no cost to the patient, there will always be some people without insurance at a given moment. Brown writes:

What about undocumented women? Or those between jobs and temporarily uninsured? … Or domestic abuse victims who want to keep this information from their husbands? These are just a few of the situations in which a woman would find OTC pills much more accessible and affordable than the prescription-only kind, even if those prescription pills came with no co-pay. 

What's more, when it comes to a medication's effectiveness, studies show that convenience matters. If someone can run out to the drug store at whatever time of day is best for her, she's less likely to miss doses. "Being able to easily get the pill when you need it makes a difference," Dr. Dan Grossman of the University of California, San Francisco, told Yahoo! News in 2012.

Beyond the practical policy advantages of allowing women to buy birth control over the counter, such a change would also have positive ramifications for employers and insurance providers who have moral objections to offering contraception coverage.

One of the hottest-burning controversies over the last few years has been around whether religious business owners can be made by the Department of Health and Human Services to pay for no-cost contraception for their workers. In 2014, the Supreme Court ruled that in the case of closely held, family-run companies like Hobby Lobby, the answer is no. In 2016, the Court is expected to decide whether the same goes for religious nonprofits such as schools, hospitals, and charities.

But this is only an issue because contraceptives are treated as controlled substances—things that women can't just walk into any drug store and plunk down a few dollars to get. If many types of birth control were available at many different price points, and no health insurance were needed to make their purchase possible, the government's purported "compelling interest" in ensuring people have access to family planning services would be met. Obamacare's contraception mandate would therefore be unnecessary—and employers with conscience objections, religious or not, would be off the hook.

What if an administration wanted to go further and ensure women could get those services for free? It's actually not clear to me why birth control should be available at no cost—after all, humans would die without food, yet we don't think the government is "compelled" to pay everyone's grocery bill.

Still, even if you think contraceptives are for some reason a special case, the government could always offer subsidies directly to the purchaser. There's absolutely no reason employers or insurers would need to be involved in the transaction.

One last point: You don't have to agree with the employers who view birth control as morally problematic in order to oppose government violations of those employers' conscience rights. Nor, by the way, do you have to agree with the view of birth control as an unadulterated good in order to oppose government restrictions on the lives of those people who choose to use it.

Whether you're mostly concerned about empowering women or stopping infringements on religious liberty, the conclusion is the same: It's time to get the requirement for a prescription out of the birth control equation.