Referencing a study comparing continued use of the pill between women who could buy it over the counter in Mexico vs. matched women who received it through standard U.S. insurance or health-clinic plant, blogger Emmma of The Well-Timed Period says
Researches wanted to test the hypothesis that making access to the Pill more convenient — by 1)removing the prescription requirement, and 2) providing users with more Pill packs — could increase Pill use and continuation.
They recruited 1046 current Pill users living in El Paso, TX, a setting where low-income women can obtain the Pill without a prescription by crossing the border into Mexico and buying the Pill OTC from a Ciudad Juarez pharmacy. [532 women received Pill packs with a prescription from an El Paso clinic and 514 women purchased the Pill OTC from a Ciudad Juarez pharmacy.]
The study found that discontinuation was significantly lower for women who used the pharmacy to buy the Pill than for clinic users. When the number of Pill packs was taken into account, discontinuation rates were higher…for clinic users who received one to five pill packs. Only clinic users receiving 6+ pill packs had continuation close to pharmacy users.
If you’re talking about medications with short-term use like antibiotics or
pain killers there might be an excellent case for distributing only limited supplies. For most women who take the pill it’s a long-term proposition. And while many women discontinue use because they have side effects they don’t enjoy, studies like this one (see also) suggest inconvenience is a big factor as well.
I mean, it would be bad enough if you could only by a month’s worth of toothpaste or floss at a time… and then you could only get new supplies at the store you bought it the first time.
Bwahaha, listen to me talking about it as though it was a hypothetical instead of how it works basically everywhere in the U.S.
Sheesh!
That’s interesting. I wonder
Submitted by FD (not verified) on Sun, 2010-08-29 15:15.That’s interesting. I wonder whether the limiting factor is finance or the inconvenience? I note that the linked blog specifically states ‘low income women’. Is there a co-pay charge for contraceptive prescriptions?
(In the UK all contraception is point of access free, courtesy of the NHS.) For the pill, the normal prescription length is 6 months, then a nurse/Dr appt to check blood pressure etc is required before the next 6 months is issued. If you’re stuck and can’t come to the surgery for some reason, they will issue a short prescription to tide you over till you can make an appointment.
I can’t see a logical reason for only issuing one month at a time – and why on earth would you have to get your refills at the same pharmacy?
Contraceptive pills cost a
Submitted by zilla (not verified) on Mon, 2010-08-30 06:30.Contraceptive pills cost a small fortune if you just buy them at the regular pharmacy. When I was making minimum wage, one month worth of pills at the pharmacy cost me a full day’s wages. Subsidized pills are available only at certain places like Planned Parenthood or college health centers, and even there the discount was only to half the price of the pharmacy. When I was in college and got pills from the campus health center, they made you come back every month to show your student ID so you could get another pack. At least the health center was very close to the dorm. When I got them at Planned Parenthood, you could get a year’s worth all at once, if you could afford it. But if a year’s worth of subsidized pills still costs a week’s wages, and how many low income people can do that? Especially when they’re also paying for an exam at the same time. So instead some of those women are spending four hours on a bus to go to Planned Parenthood once a month. And depending on the size of the city and the personnel/financial/regulatory constraints the clinic operates under, the clinic hours may be very limited, which makes it even harder to get there every month for supplies.
One time I had a really rough time getting to the clinic for my exam appointment – a tough escape from work made me miss a bus, I ran a few blocks to make a creative connection to another bus so I could get there on time, had an argument with bus driver over whether my transfer slip was allowable since the bus it came from didn’t intersect at this spot, and so on. I arrived at PP completely lathered up from stress, and my blood pressure was too high. They decided I must come in twice in the next two weeks and have it checked again or they wouldn’t write the script. So, two more fights to escape work, two more bus trips, etc, and in the meantime they cut a pill pack in half and gave me just a partial month so my coverage wouldn’t lapse. Complete pain!
And before I discovered Planned Parenthood, I had a dreadful experience with a clinic that advertised to low income women, where they did the exam and wrote me a prescription, but refused to write it for the pill that had been working fine for me when I’d still been in college – no, they wanted to switch me to another pill, that made me bleed all the time. And when I pleaded over and over to be switched back they told me to tough it out, the bleeding would stop eventually. After three months I gave up and scraped together the money for another exam, so I could switch to another clinic, which is how I ended up at Planned Parenthood. Thinking back on that first clinic, I wonder if they were basically approaching this from the same direction as one of those creepy crisis pregnancy centers, and trying to punish me for having premarital sex?
Anyway, yeah, if I were a low income woman in El Paso, I’d totally be crossing the border for OTC pills. Heck, I’m no longer low income, and I still cross into Canada for OTC allergy pills. The doctors are a lot less stingy with allergy pill prescriptions than they are with oral contraceptives, but it still saves me time, money and hassle, to just go get the allergy pills in Canada.
Your stories about the hassle
Submitted by figleaf on Mon, 2010-08-30 07:47.Your stories about the hassle are so familiar, Zilla! Planned Parenthood is pretty great but a little procedural, public health departments are increasingly getting out of dispensing the pill, insurance companies are almost bizarrely hung up about short refill timelines, and underage and low-income women really, really have to scramble. That was true when I was in high school decades ago and it’s still true now.
The blood pressure issue is a reminder why providers are concerned about unrestricted OTC sales of contraceptive pills. There really can be side effects. And so, yeah, it would really be a good idea to let your caregiver know you were taking them, and to ask a caregiver for an assessment before you start using them. The same can be said of a lot of OTC medications, acetaminophen (a.k.a. Tylenol) being only the most notorious. But that doesn’t mean those medications should be made prescription only, and there seems to be a growing consensus that neither should the pill.
Thanks!
fl
Oh, and I forgot to say… if
Submitted by zilla (not verified) on Mon, 2010-08-30 06:37.Oh, and I forgot to say… if you are fortunate enough to have health insurance, and even more fortunate in having health insurance that covers contraceptive pills (many don’t), you have to go get them from the pharmacy, one month at a time, because most insurance will only let you get 30 days worth of meds at once. But at least you can go to any pharmacy.
The last five or six years I was on the pill, I had insurance that didn’t cover them, but I was earning enough money to buy a full year’s worth at a time. Whew!
In Washington when you sign
Submitted by Anonymous (not verified) on Mon, 2010-08-30 21:45.In Washington when you sign up with Planned Parenthood for their free birth control you get a whole years worth at once. It was kind of a pain to keep track of, but I wish that my insurance would let me do that now, they’re only paying for about 20% of the full cost anyway, so I don’t see why they should care whether they pay for it all at once or have to run the whole thing through the system every three months.
Plus the pharmacy read the scrip wrong this year and it took them forever to figure out that I had a prescription for 12 months worth of pills rather than just 6 which was only just sorted out right before it would have been a huge annoying big deal.
Convenience is a very big
Submitted by Eve (not verified) on Wed, 2010-09-01 10:33.Convenience is a very big deal. I’m extremely lucky in that regard. I happen to be young enough to still be on my mom’s health insurance, which is payed for in full by her employer (I wonder if the importance he places on providing that to his employees has anything to do with his being from Belgium?). Said insurance (Kaiser Permanente) covers birth control, including allowing me to switch brands as many times as I need to find one that works (no forcing me to stay with a pill that makes me crazy). They let me have 3 months worth at a time, for which I only pay a $5 copay. I am allowed a year worth of refills before I have to come in again, and they’re flexible about that too. Kaiser pharmacy will ship my prescription to my home free of charge, but if I didn’t have that option, the nearest Kaiser pharmacy (and hospital) is a 15 minute walk from my home. I’m also lucky enough to live in California in the San Francisco bay area, where you generally never hear about pharmacists refusing to fill prescriptions or doctors refusing to prescribe contraception to unmarried women or teens.
I also realize how much of that is simply luck. And it shouldn’t be that way. It isn’t right that I should only have all of that available to me because of luck. And it isn’t right that anyone else should not have any of that just because they aren’t that lucky. It should be a given for everybody.