Contraceptive Pearl: Over-the-Counter Access to Oral Contraceptives: An Update

This is an updated version of our September 2022 Contraceptive Pearl written by H. Reeve Bright, with updates written by Ruth Lesnewski. You can read September 2022’s Contraceptive Pearl on our website.

Over-the-counter (OTC) oral contraceptive pills (OCPs) are available in over 100 countries. Requiring a prescription for OCPs creates access barriers, especially for the approximately 30 million Americans who lack health insurance. As of May 2023, 26 states and the District of Columbia offered pharmacist-prescribed birth control pills, but no states offered over-the-counter OCPs.¹ HRA Pharma applied for FDA approval for an OTC progestin-only pill.² On May 10, 2023, an FDA advisory panel voted unanimously to recommend approval, meaning that a progestin-only oral contraceptive may become available without a prescription throughout the US.

The American Academy of Family Physicians has long supported OTC OCPs as a way to increase access to contraception.³ The American College of Obstetricians and Gynecologists (ACOG) reaffirmed its support of over-the-counter birth control, including OCPs, without age restriction. The Free the Pill coalition has organized support for OTC OCPs since 2004.

Multiple studies have shown that persons who can get pregnant can use a self-screening tool to determine their eligibility for various forms of hormonal contraception.. Progestin-only pills carry minimal risk of venous thromboembolism (VTE),¹⁰  and may have efficacy similar to that of estrogen-containing OCPs.¹¹

Over-the-counter status for a progestin-only pill makes this method much easier to obtain, assuming that pills accessed this way are fully covered by insurance, inexpensive for those without insurance, and available to people of all ages.

RHAP resources:

Your Birth Control Choices Fact Sheet

Your Birth Control Choices Poster

Progestin-Only Pill (Mini-Pill) User Guide


1. What’s the law in your state? Free the Pill. Published January 1, 2022. Accessed August 23, 2022.

2. Aubrey A. Over-the-counter birth control pills are available worldwide. The U.S. may be next. Published July 14, 2022. Accessed August 23, 2022

3. Over-the-Counter Oral Contraceptives. Published 2014. Accessed August 23, 2022

4. Committee Opinion 788: Over-the-Counter Access to Hormonal Contraception. Published October 2019. Accessed August 23, 2022.

5. Shotorbani S, Miller L, Blough DK, Gardner J. Agreement between women’s and providers’ assessment of hormonal contraceptive risk factors. Contraception. 2006;73(5):501-506. doi:10.1016/j.contraception.2005.12.001

6. Grossman D, Fernandez L, Hopkins K, Amastae J, Garcia SG, Potter JE. Accuracy of self-screening for contraindications to combined oral contraceptive use. Obstet Gynecol. 2008;112(3):572-578. doi:10.1097/AOG.0b013e31818345f0

7. Doshi JS, French RS, Evans HE, Wilkinson CL. Feasibility of a self-completed history questionnaire in women requesting repeat combined hormonal contraception. J Fam Plann Reprod Health Care. 2008;34(1):51-54. doi:10.1783/147118908783332203

8. Yeatman SE, Potter JE, Grossman DA. Over-the-counter access, changing WHO guidelines, and contraindicated oral contraceptive use in Mexico. Stud Fam Plann. 2006;37(3):197-204. doi:10.1111/j.1728-4465.2006.00098.x

9. Kaskowitz AP, Carlson N, Nichols M, Edelman A, Jensen J. Online availability of hormonal contraceptives without a health care examination: effect of knowledge and health care screening. Contraception. 2007;76(4):273-277. doi:10.1016/j.contraception.2007.06.009

10. FDA Drug Safety Communication: Updated information about the risk of blood clots in women taking birth control pills containing drospirenone. Published February 13, 2018. Accessed August 23, 2022.

11. Zuniga C, Blanchard K, Harper CC, Wollum A, Key K, Henderson JT. Effectiveness and efficacy rates of progestin-only pills: A comprehensive literature review. Contraception. 2022;119:109925. doi:10.1016/j.contraception.2022.109925


The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.