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Here's What Over-The-Counter Birth Control Would Actually Be Like

It would obviously be convenient, but what would it cost?

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Over-the-counter birth control is a thing that could maybe exist in the future.

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Two states have already made it possible to get a prescription from a pharmacist, rather than going to your doctor.

Donald Trump on Thursday told Dr. Oz that he supports prescription-free birth control.

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During Trump's appearance on The Dr. Oz Show, Oz asked him if he thought women should be reimbursed for birth control costs.

Trump responded: "When you have to get a prescription, that’s a pretty tough something to climb,” he said. “And I would say it should not be a prescription; it should not be done by prescription.”

He continued, "You have women that just aren’t in a position to go get a prescription. So and more and more people are coming out and saying that, but I am not in favor of prescription for birth control."

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It sounds like a great idea in theory: your birth control right there next to the aspirin or tampons.

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No more scheduling a gyno appointment, waiting forever to see a doctor, and sitting on a paper towel with your legs in the stirrups every time you need to renew your Rx. No more dealing with insurance companies who won't give you next month's prescription before you head off on a trip. No more dealing with pharmacists at all, maybe.

But OTC birth control remains a controversial topic in reproductive health community. Here are a few things to consider:

First, which methods would be available over the counter?

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The most effective reversible birth control methods are the IUD and implant, with a failure rate of less than 1%. But these obviously couldn't live right there on aisle six since they need to be inserted by a doctor. Ditto for the contraceptive shot (which has a failure rate of between 1–6%), which involves an injection by your doctor every three months.

So, when we talk about prescription-free birth control, we're really talking about the pill, the patch, and the ring. While still very effective methods, they're susceptible to more user error. With typical use, these methods can have up to a 9% failure rate.

So it's possible that OTC birth control could affect which methods some women use. "The whole point of the Affordable Care Act contraceptive coverage piece is that if you take the cost barrier away, then women can choose from the full range of methods and find whats perfect for them," Rachel Fey, director of public policy at the National Campaign, told BuzzFeed Health.

Cost is another major issue. If birth control moves over the counter, you might have to pay for it again.

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Currently under the Affordable Care Act, all FDA-approved birth control methods are covered without a co-pay as long as you have insurance and are prescribed them (there are a few exceptions, which you can find out more about here).

But if birth control is available without a prescription, there's a chance that we could go back to paying out of pocket. According to Fey, the primary question for anyone endorsing OTC birth control is: "Do you mean in addition to insurance coverage for the full range of methods, or instead of?"

The American Congress of Obstetricians and Gynecologists (ACOG) recently reaffirmed their committee opinion on OTC birth control access, and they're in favor of it. However, they also note: "It is possible that some women might be adversely affected by changing to over-the-counter [oral contraceptives] if they lose insurance coverage for their preferred contraceptive method."

That said, there is some precedent to show that insurance might still cover OTC birth control — if you get a prescription.

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Dr. Daniel Grossman, professor at University of California San Francisco and director of Advancing New Standards in Reproductive Health, told BuzzFeed Health that it's possible we could see a system that offers both prescription-free and insurance-covered birth control.

For instance, Plan B One-Step emergency contraception went OTC in 2013. However, many insurance companies and state Medicaid programs will still cover it if you get a prescription.

So it's possible that OTC birth control would work the same way: covered by insurance with a prescription, or available at a retail price without one, said Grossman.

OTC birth control may also come with restrictions on who can access the pill.

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We saw this when Plan B One-Step initially moved over the counter. It was suddenly easier to access — but only for those 15 and older, and only if you showed your ID to the pharmacist.

One bill recently introduced in the Senate, the Allowing Greater Access to Safe and Effective Contraception Act, would encourage the FDA to prioritize OTC birth control applications — but only "for routine use that would be available to individuals aged 18 and older without a prescription."

This would limit access for teens at a high risk for unintended pregnancy, as well as anyone without an ID, Jessica Arons, president of the Reproductive Health Technologies Project, told BuzzFeed Health.

Medically speaking, doctors agree that birth control pills are safe enough to be sold over the counter.

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"This is one of the best studied medications that is out there," said Grossman. "It's very safe and effective when used appropriately and really does meet the criteria of being available without a prescription."

He added that there is no medical reason for there to be an age restriction. However, if you have a question about your health, risk factors, or which method is best suited to you, it couldn't hurt to talk to your doctor or pharmacist.

His hunch is that the first OTC birth control pill will be a progestin-only pill (better known as the minipill), rather than the more popular combined oral contraceptives, which contain both progestin and estrogen.

That's because the progestin-only pill comes with fewer contraindications than pills containing estrogen. The downside of this method is that you really need to take it within the same three-hour window every day for it to be effective.

It's also important to note that presidents don't decide whether or not a drug moves over the counter — the FDA does. And it can take years for that to happen.

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In order for a medication to go from prescription-only to over-the-counter, the pharmaceutical company has to apply to the FDA, providing extensive research on the safety of the drug, the comprehensiveness of the label, and the ability of consumers to accurately determine if they're a good candidate for it, among other things, explained Grossman.

That research could take a few years, he said, and the approval process could take another year or two after that. Essentially, this isn't something that would translate from interview soundbite to store shelves anytime soon.

"It's interesting for politicians to really weigh in on this," said Grossman. "But in terms of the actual approval of an over-the-counter pill ... that should really be in the hands of the FDA exclusively."

The bottom line: Increased access to birth control would be amazing. But only if it remains cost effective and accessible to everyone who needs it.

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"It's not going to have the hoped for impact on reducing unintended pregnancy and really helping women meet their contraceptive needs unless it's also available at an accessible cost and ideally covered by insurance," said Grossman.

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