2. Availability and Accessibility of an Over-The-Counter Oral Contraceptive Pill in Retail Pharmacies in a Single Midwest US County: An Exploratory Study

Abstract

Background

An over-the-counter (OTC) oral contraceptive pill (OCP) containing 75 μg of norgestrel became available without a prescription in US retail stores in March 2024. OTC access to an OCP has the potential to reduce barriers to contraceptive access and improve reproductive health equity, particularly for adolescents; however, removing the requirement for a prescription does not guarantee accessibility. The purpose of this study was to assess the availability and accessibility of the OTC OCP in pharmacies in a single midwest US county.

Methods

We used our state's licensing database to identify all licensed retail pharmacies in our county and visited these pharmacies between August and October 2024; we excluded pharmacies embedded in clinics and hospitals. We observed the availability, price, and accessibility of the OTC OCP (“the pill”), including availability for purchase of one- and three-month packs, price, and location (on the shelf with no security measures; behind the pharmacy counter; or in a locked security box that requires an employee to open at checkout). We present descriptive statistics of our findings.

Results

We visited a total of 44 retail pharmacies, including 16 standalone chain pharmacies, 14 independent local pharmacies, 12 mass merchandise retailers/supermarkets, and two wholesale clubs. The pill was available in 33 pharmacies (75% of those visited). Only three of 14 independent pharmacies (21%) carried the pill. Prices ranged from $18.97- $22.59 for one-month packs (manufacturer's suggested retail price [MSRP]: $19.99) and $47.99 - $55.99 for three-month packs (MSRP: $49.99). In 12 pharmacies (36%), the pill was available on the shelf with no security measures. In 13 pharmacies (39%), the pill was in locked security boxes. In 4 pharmacies (12%), some packs were available on the shelf, while others were in locked security boxes. Four pharmacies (12%) had the pill behind the pharmacy counter.

Conclusions

The OTC OCP was available at most pharmacies (75%) in our single US county at the time of data collection; however, few independent pharmacies stocked the product, and only 27% of all pharmacies had the product available without security measures. Prices in our county were generally similar to the MSRP. In more than half (63%) of pharmacies that stocked the pill, the OTC OCP was locked in security boxes or behind the pharmacy counter, requiring an individual to seek an employee to access the pill. Whether these measures affect adolescents' willingness to purchase the OTC OCP or contribute to stigma around contraception are important areas for future study.