CVS drug plans will cover new OTC birth control pill for free

CVS prescription drug plans will cover the first nonprescription birth control pill in the U.S., eliminating a potential cost barrier for many women. 

The company’s pharmacy benefit manager (PBM), CVS Caremark, said Opill will be added to its preventive services oral contraceptives list for April 2024, meaning it will be covered at no cost for many sponsors.  

Opill was available in store at CVS pharmacies starting April 1. CVS is the first major pharmacy benefit manager to cover Opill, which could open the door to even wider coverage. 

PBMs are the intermediaries in the prescription drug supply chain that negotiate discounts with drug companies on behalf of insurance plans. PBMs decide which drugs will be on a covered list of drugs, called a “formulary,” and how much a patient will have to pay for them.  

Three PBMs dominate the U.S. market: CVS Health’s Caremark, UnitedHealth’s Optum Rx and Cigna’s Express Scripts.  

The Affordable Care Act requires insurers to cover preventive services including specific types of birth control, but only if they are prescribed. Insurers usually don’t cover over-the-counter (OTC) products. 

A few states require state-regulated private health insurance plans to cover OTC contraception, but those rules don’t apply to most employer-sponsored plans.   

“Perrigo is thrilled to see Caremark joining us in the effort to increase access to safe and effective contraceptives, like Opill, for women and people who want them. We encourage consumers to regularly check with their insurance providers and individual plans to understand what coverage of Opill may be available to them,” Triona Schmelter, executive vice president and president of Consumer Self-Care Americas at Perrigo, the pill’s manufacturer, said in a statement to The Hill. 

Studies have shown even a small cost barrier could present significant challenges to accessibility. People who are uninsured or underinsured will still have to pay out of pocket, though the manufacturer has a patient assistance program to defray the cost.

A month’s supply of Opill carries a recommended cost of $19.99, while the company recommends a three-month supply cost of $49.99.  

A survey from health policy research group KFF in 2022 found nearly 40 percent of reproductive-age women would be willing and able to pay between $1 and $10 per month for such a medication, and 34 percent would be willing and able to pay up to $20 per month. But only about 16 percent would be willing and able to pay more than $20 per month. 

Opill was approved in July as the first ever OTC birth control pill in the U.S. When taken as directed at the same time every day, Opill is up to 98 percent effective at preventing pregnancy. 

Reproductive health experts have said making birth control pills available without a prescription has the potential to be a game changer, especially for younger women and those in rural and underserved communities. 

The push to make birth control available over the counter has been happening for years, but after the Supreme Court overturned Roe v. Wade and ended the constitutional right to an abortion, the movement took on more urgency. 

The ruling has also made it harder to separate the issue of contraception from the politics of abortion.