While the issue of whether to allow hormonal contraceptives to be sold over the counter continues to be a political lightning rod, an access-improving development has quietly taken root without attracting controversy: An array of new apps and websites now make it possible for women to obtain prescription contraceptives in many states without having to schedule a doctor’s appointment.
Thanks to game-changing program offerings from Nurx, Maven, Lemonaid, Virtuwell andPrjkt Ruby, women can answer questions about their health online or by video; the information is then reviewed by a doctor or nurse practitioner who will write a three-month prescription for oral contraceptives that patients can pick up at a nearby pharmacy or in some cases have delivered right to their homes. These services are offered to women who are currently taking the birth control pill as well as those who have no prior experience with it. As an alternative, in a handful of states, you can have a video visit with a Planned Parenthood clinician who can then prescribe you an oral contraceptive.
With these digital programs, “the primary benefit is increased access to contraception,” says Dr. Nathaniel DeNicola, an OB-GYN at the University of Pennsylvania and the American College of Obstetricians and Gynecologists expert on mobile and social media. “The hope is that this will increase utilization of some forms of contraception and improve birth control adherence and compliance, which is an enormous issue.” Indeed, 45 percent of all pregnancies in the U.S. are unintended, according to a 2016 report from the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights, based in New York City.
In recent years, there has been a major push to improve access to contraception nationwide. Under the Affordable Care Act, private insurers are increasingly covering the cost of oral contraceptives, which helps minimize or eliminate the financial barrier. Many of these apps and online programs accept insurance, including Medicaid, and charge a modest fee for their services; for people who don’t have insurance, birth control pills can be obtained for as little as $15 a month through some of these ventures.
While some physicians are concerned that providing access to hormonal contraception without requiring a doctor’s visit could lead women to think they can shirk OB-GYN visitsentirely, others don’t see it that way. DeNicola, for example, views this kind of service as providing another touch point to traditional care. “The real promise of telemedicine is that it doesn’t replace traditional medical care – it augments and enhances it,” he says. After all, there is a physician involved with these apps and online services, and they must followtelemedicine regulations.
Besides, “people should not be denied birth control because they won’t come in for a Pap smear – we shouldn’t be holding people hostage,” says Dr. Anne Davis, an OB-GYN based in New York City and consulting medical director for Physicians for Reproductive Health, a nonprofit organization dedicated to improving access to comprehensive reproductive health care, including contraception. Moreover, the annual Pap smear “is a thing of the past; we don’t do annual Pap smears anymore,” she adds. So these apps and websites make it more convenient for women to obtain and stick with regular use of birth control without having to see an OB-GYN solely for that purpose.
Still, these digital offerings do have limitations. “You can’t use an app to get an IUD [intrauterine device] or an implant,” Davis points out. Only oral contraceptives are offered through these programs so users miss the opportunity to learn about other options that could suit them even better. Case in point: Over the long haul, long-acting reversible contraceptive methods, or LARCs, such as IUDs and birth control implants, “are 20 times more effective than birth control pills, the patch or the vaginal ring,” according to ACOG. With the long-acting options, there’s no need to remember to take a pill each day; once inserted, the device stays inside you for two to 10 years.
Meanwhile, if you have a chronic medical condition, you’d be better of having a face-to-face discussion with your doctor about whether hormonal contraceptives are even safe for you. With some of these digital ventures, women over age 35 are limited to a progestin-only pill because the risks associated with taking combination estrogen-progestin oral contraceptives are higher for women in this age group. High blood pressureand diabetes are more common after age 35, and if these conditions are poorly controlled, taking estrogen-containing birth control pills can be problematic, DeNicola says.
With these digital programs, “there isn’t the depth of communication you’d get with a doctor-patient encounter,” DeNicola adds. “So risks your doctor might think of wouldn’t be addressed by the current generation of apps.” Your doctor also might caution you against taking the combination pill if you engage in frequent air travel or have migraines with aura because of an increased risk of blood clots, whereas an app wouldn’t be able to raise those concerns, he explains.
Nevertheless, these digital offerings remove some barriers to contraception that people might otherwise encounter. Gone is the necessity of having to take time off from work or family obligations to see a doctor for nothing more than an Rx for birth control pills – or to get a provider on the phone to request a refill. “We’re trying to be smarter and more patient-centered about providing access to contraception,” Davis says. With these online services, “it’s a lot easier to make that happen.”
Corrected on June 30, 2016: A previous version of this article misstated the name of Physicians for Reproductive Health and didn’t make it clear that annual Pap smears, not annual OB-GYN visits, are a thing of the past.