reproductive health

What You Need to Know About the New Over-the-Counter Birth Control Opill

Photo-Illustration: by The Cut; Photo: Opill

For many people — including young people, low-income people, and people who live in rural areas with sparse access to medical care — just getting a prescription for birth control can be a formidable task. While the Affordable Care Act requires insurance to fully cover the cost of birth control, that’s only useful if you can find time to get to the doctor in the first place (and not useful at all if you don’t have insurance). But it doesn’t have to be this way.

In most of the world, birth control is available over the counter, without a prescription. And this month, America is finally catching up to the global consensus. On March 18, Opill — the first FDA-approved over-the-counter birth-control pill — will be available for sale online at and hitting the shelves of pharmacies around the country within the next few weeks.

Wondering if Opill is right for you? We sat down with Dr. Raegan McDonald-Mosley, a practicing gynecologist and the CEO of Power to Decide, as well as the chief medical adviser to the Contraceptive Access Initiative and a member of the Free the Pill steering committee, to learn everything you need to know about Opill.

What is Opill and how does it work?

Opill is a daily birth-control pill manufactured by Perrigo, the pharmaceutical company behind the emergency contraception pill Ella and Hana, an over-the-counter birth-control pill that’s available in the U.K.

More specifically, Opill is a progestin-only pill, also known as a POP or mini-pill. Progestin is the hormone that powers most hormonal birth-control methods — including Plan B, hormonal IUDs, the implant, and the shot — but in the most commonly used birth-control pills (known as combination pills, a category that includes Ortho Tri-Cyclen, Yaz, Sprintec, and many others), it’s accompanied by estrogen.

Mini-pills and combination pills are both effective at preventing pregnancy, but there are some key differences between them that are important to know about. While combination pills give you three weeks of active pills and one week of placebo pills, Opill is four straight weeks of active pills. That means you won’t get a regular period like you might expect (though some people do experience occasional spotting and breakthrough bleeding).

And because it’s progestin-only, Opill needs to be taken at the same time every day. With perfect use, Opill is 98 percent effective at protecting against pregnancy. But if you miss a pill, or take a pill at a different time, the effectiveness rate can drop to 92 percent — which still makes it one of the most effective over-the-counter birth-control methods on the market.

According to the FDA, common side effects can include “nausea, breast tenderness, and headaches,” though they’re “generally mild and often resolve on their own.”

Who is Opill for?

Anyone who wants a daily contraceptive pill — but doesn’t want to have to go to the doctor to get it.

Though it may not seem like a major hurdle, requiring a prescription for birth control makes it functionally inaccessible for some people. Not everyone has the time or insurance coverage they need to go see a doctor. Not everyone wants a birth-control prescription to show up on their insurance bill — especially if that insurance bill is monitored by their parents or an abusive partner. Even something as basic as feeling uncomfortable talking to your doctor about sex can make prescription birth control off-limits for you.

In contrast, over-the-counter birth control doesn’t require a doctor’s appointment, insurance coverage, or a conversation about your sex life — and you don’t have to show an ID to get approved for it. Plus, you can buy it online and avoid a trip to the drugstore altogether.

Also, because Opill doesn’t contain estrogen, a lot of people who can’t take combined estrogen-progestin pills can take Opill. Pregnant people, people who are allergic to any of Opill’s ingredients, and people with breast cancer should avoid Opill, but for everyone else, it should be safe.

How do I get Opill and what does it cost?

Starting March 18, Opill will be available for sale at It’ll also be available at drugstores around the country and through online pharmacies. The suggested retail price for $19.99 for a one-month supply or $49.99 for a three-month supply, though the cost may vary from retailer to retailer. At, it will be available for $49.99 for a three-month supply and $89.99 for a six-month supply.

Is it possible to get Opill for free?

With any luck, yes. “Research has shown that even this price point may be out of reach for a lot of people,” says Dr. McDonald-Mosley, noting that many young people can’t afford to spend more than $10 a month on over-the-counter birth-control pills.

Right now, there’s no protocol in place for getting your insurance to cover Opill, though it may be reimbursable through Flexible Spending or Health Savings Accounts (also known as FSAs/HSAs), the same way that other over-the-counter medications are. FSA/HSA reimbursements are dependent on the specific details of your plan, however, so that’s not guaranteed.

And since the Affordable Care Act requires that insurance fully cover birth control, Dr. McDonald-Mosley is hopeful that insurance coverage for Opill will be coming soon. “It’s really important that we figure out a way for insurance to cover over-the-counter birth-control products,” she says.

So … is everything fixed for reproductive health?

Not quite, though this is still a major win. The fight for over-the-counter birth control in the United States has been going on for 20 years — and it’s a huge victory to see those decades of hard work finally come to fruition. It wasn’t some pharmaceutical breakthrough that made this possible: mini-pills have been around for 50 years. Think of it as more of a cultural breakthrough: The approval of over-the-counter birth control means that it’s no longer taboo in the United States to suggest that people should have the ability to make decisions about their reproductive health by themselves, without the oversight of a doctor.

But while Opill will be available in all 50 states, it’s not a panacea. Opill isn’t right for everyone, and “people should be able to have access to all [birth-control] methods without unnecessary barriers and restrictions,” says Dr. McDonald-Mosley. “While this is a huge advancement, we can’t take away all the work that needs to be done to ensure that all people have access to the full range of contraception and abortion.”

But in a world where it feels like reproductive rights are getting more limited with every passing second, easy access to birth-control pills is definitely a step in the right direction. As Dr. McDonald-Mosley says, “It’s nice to have something positive to celebrate regarding sexual- and reproductive-health access.”

What Is Opill? What to Know About the New OTC Birth Control.