D.C. starts conversation to allow over-the-counter contraception

Scrutiny from city’s pharmacy and medical boards, cost and regulation studies mean long road ahead
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Thursday, February 17, 2011 at 4:16 pm

This week, the Council of the District of Columbia introduced a bill which, if passed, would make contraceptives such as birth control pills, patches and vaginal rings available for purchase without a prescription.

While the measure could pave the way for greater accessibility to contraception to women, many questions remain to be answered, particularly how such contraceptives would be regulated. The legislation would have to undergo intense scrutiny from the city’s pharmacy and medical boards that would have to draft regulations and reconcile the fact that hormonal birth control is not one-size-fits all, like other over-the-counter drugs.

In other words, it’s going to be a while.

The bill was introduced by At-Large Councilman David Catania on Tuesday. Catania has previously worked as chairman to the council’s Health Committee and made efforts to increase access to health care and contraception to low-income residents.

As The Washington Examiner reported, officials have questioned the need for over-the-counter access to contraception. K. Edward Shanbacker, Medical Society of the District of Columbia’s executive vice president, suggested that if birth control were available without a doctor’s prescription, women might forgo annual exams.

But ultimately, Catania acknowledged he is simply introducing the conversation to council, allowing the medicine and pharmacy boards to collaborate on this issue. His legislation does not set age restrictions but leaves decision up to the boards as part of the rule-making process.

Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center, said her primary concern is on cost.

“On one hand it would provide easier accessibility,” Waxman said. “Women could just go in and take it off the shelf like cough medicine. But is it going to be covered by insurance?”

She pointed out that in D.C., women whose incomes fall 300 percent above the federal poverty line qualify for low-cost contraception under Medicaid. Raising the cost of birth control would actually make it less accessible to low-income women, she noted.

There have been recent pilot programs in Seattle and Portland, Ore., to test programs that would improve accessibility to contraception.

In Oregon, Planned Parenthood of Columbia/Willamette operated an “instant birth control” program allowing patients to apply online to receive the contraceptive pills after* consulting with doctors or nurses over the phone, but the program was phased out last year.

According to the Agency for Healthcare and Research Quality, the program served as an impetus for women to begin receiving regular women’s health examinations and screenings, but it was not successful in targeting low-income women, because the service was not covered by Medicaid.

Seattle instituted a pilot program from 2003-2005, allowing approximately two dozen pharmacists to dispense hormonal contraception to about 200 women, but the pilot did not develop into a permanent program.

Update, 5:05 p.m.: Kirsten Moore, president and CEO of the Reproductive Health Technologies Project, says in a statement to TAI:

“While the model of pharmacist-provided contraception can work well, key components, like appropriate training, patient education, and continued coverage of hormonal birth control under Medicaid and private insurance are critical to ensure the safety and success of this program.

“We know that over 90,000 women in DC need contraception, and we are pleased to see local policymakers look for new ways to expand access. There is no reason a woman should have to jump through medically unnecessary hoops just to get her birth control pills.”

*We previously incorrectly stated patients received contraceptive pills before consulting with doctors or nurses.

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