On The Economics of the Pill (2)

In an article for Bloomberg News, Virginia Postrel asks why certain types of oral contraceptive require a prescription. Here is an extract:

Requiring a prescription “acts more as a barrier to access rather than providing medically necessary supervision,” argues Daniel Grossman of Ibis Reproductive Health, a research and advocacy group based in Massachusetts, in an article published in September in Expert Review of Obstetrics & Gynecology.

Birth-control pills can have side effects, of course, but so can such over-the-counter drugs as antihistamines, ibuprofen or… Aleve. That’s why even the most common over-the-counter drugs, including aspirin, carry warning labels. Most women aren’t at risk from oral contraceptives, however, just as most patients aren’t at risk from aspirin or Benadryl, and studies suggest that a patient checklist can catch most potential problems.

To further increase safety, over-the-counter sales could start with a progestin-only formulation, sometimes called the “minipill,” rather than the more-common combinations of progestin and estrogen…Progestin-only pills, or POPs, have fewer contraindications. Unlike combination pills, they’re OK for women with hypertension, for instance, or smokers over the age of 35. The main dangers are fairly rare conditions such as breast cancer or current liver disease. “Not only are POP contraindications rare, but women appear to be able to accurately identify them using a simple checklist without the aid of a clinician,” declares an article forthcoming in the journal Contraception.

Aside from safety, the biggest argument for keeping birth- control pills prescription-only is, to put it bluntly, extortion. The current arrangement forces women to go to the doctor at least once a year, usually submitting to a pelvic exam, if they want this extremely reliable form of contraception. That demand may suit doctors’ paternalist instincts and financial interests, but it doesn’t serve patients’ needs. As the 1993 article’s authors noted, the exam requirement “assumes that it would be worse for a woman’s health to miss out on routine care than it would be to miss out on taking oral contraceptives.”

And let’s not forget how these requirements fit in with the even more interfering instincts of the nanny state.

The consequences are predictably malign:

Going to the doctor is costly in time, money and sometimes in dignity. Not surprisingly, the prescription requirement deters use of oral contraceptives. In a 2004 phone survey, 68 percent of American women said they would start the pill or another form of hormonal birth control, such as the patch, if they could buy it in a pharmacy with screening by a pharmacist instead of getting a doctor’s prescription. Two-thirds of blacks and slightly more than half of whites and Latinas surveyed said they chose their current, less-effective method of birth control because it didn’t require a prescription.

If you think that the costs involved in all this are incurred solely by those looking to get obtain oral contraceptives, you are a very trusting soul.

And, as I discuss in a different context over on the Corner (the availability of the emergency anti-allergy EpiPen), unnecessary insistence on prescriptions is not confined to contraceptives.