• The Biden-Harris administration has proposed a new rule that would significantly expand contraception coverage for 52 million females of reproductive age.
• If finalized, the rule would require private health insurers to cover over-the-counter birth control and other contraceptives at no additional cost to patients.
• With reproductive rights at the forefront of the 2024 U.S. presidential election, access to contraception has never been more important.

For the first time in more than 10 years, the Biden-Harris administration has proposed a rule aiming to significantly expand contraception coverage under the Affordable Care Act.

The rule would provide access to over-the-counter birth control pills and other contraceptives to 52 million women in the United States with private health insurance at no cost, the White House announced on October 21.

The proposal from the Departments of Health and Human Services (HHS), Labor, and the Treasury would build on the ACA mandate requiring private health insurers to cover contraception as preventive care without cost-sharing.

This means for the first time, females of reproductive age could obtain OTC contraceptives without a prescription at no additional cost, such as emergency contraception and Opill, the first FDA-approved OTC birth control pill that recently became widely available across the U.S.

If finalized, the rule is expected to go into effect sometime in 2025. It would be the largest expansion of contraceptive coverage under the ACA since 2012.

Since the U.S. Supreme Court overturned Roe v. Wade in 2022, the Biden-Harris administration has remained committed to reproductive rights by strengthening contraception access and affordability under the ACA through Medicare and Medicaid, the White House said.

While most people with health insurance can already obtain free birth control, the addition of OTC birth control at no additional cost could further improve access.

“When someone needs to get their birth control pills over the counter, it should be covered by health insurance,” said Sarah W. Prager, MD, a professor in the Department of Obstetrics and Gynecology at the University of Washington School of Medicine.

“People need to access over-the-counter contraception for lots of reasons, including traveling and forgetting to bring pills, running out of the prescription, and needing to stay covered until getting in to see a provider. Extending health insurance to birth control pills that are obtained over the counter just makes sense,” Prager told Healthline.

OTC birth control helps prevent unplanned pregnancy

Opill, the only daily birth control pill from drug manufacturer Perrigo, is approved for use without a prescription by the Food and Drug Administration (FDA).

Under the Biden-Harris administration’s proposed rule, OTC contraceptives like Opill would be covered without cost-sharing.

Other methods of birth control, such as sponges, condoms, and spermicides would be covered under the new rule, as well as some contraceptive devices, such as intrauterine devices (IUDs). Emergency contraceptives like Plan B, the morning-after pill, would also be provided at no additional cost.

With reproductive rights at the forefront of the 2024 presidential election, access to effective and affordable contraceptives has never been more important.

Kecia Gaither, MD, MPH, double board certified OB-GYN and maternal-fetal medicine specialist and director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, agreed OTC birth control is key for preventing unintended pregnancies.

“Easier access reduces the likelihood of unintended pregnancies, which can have significant economic, social, and emotional consequences for women and their families,” Gaither told Healthline.

“Allowing OTC birth control enhances [a person’s] autonomy — [they have] more control over their reproductive health without requiring consultation with a healthcare provider,” she added.

Gaither listed other ways OTC birth control is an essential aspect of preventive care:

• Increased accessibility: Obtaining birth control and emergency contraceptive pills without a prescription or a doctor’s visit can lower barriers to access, which is crucial for people in rural or undeserved communities and those who live in “medical deserts.”
• Immediate availability: OTC birth control can be obtained quickly, and discretely, making them more effective when taken soon after intercourse without a barrier method.
• Cost-effective: OTC contraceptives may be more affordable than a doctor’s visit and a prescription, which helps alleviate financial barriers to obtaining contraception.
• Public health impact: Access to free birth control can help lower the incidence of sexually transmitted infections (STIs), which can contribute to better overall public health outcomes. Of course, not all birth control methods, such as condoms, lower the risk of STIs.
• Increased health literacy: OTC contraceptives often come with simplified instructions, which help enhance awareness and understanding of reproductive health.

Takeaway

The Biden-Harris administration proposed a new rule on October 21 that would significantly expand coverage for contraceptives, including OTC birth control and emergency contraception. With reproductive rights at the core of the 2024 presidential race, access to effective and affordable contraceptives has never been more crucial.