This month, an online service that prescribes and delivers birth control methods called The Pill Club announced that it’s now available to residents in New York, in addition to Arizona, California, and other seven US states. A few other companies in the US like HeyDoctor, Lemonaid, and Nurx provide online prescriptions for contraceptives like the pill, the patch, or the ring — without the need to see a doctor. But why would anyone want to order contraceptives online?
For one thing, it’s easier and faster. Right now, to get a prescription, you need to see a primary care physician or a gyno. That usually means taking time off work and waiting for the appointment. “I’m a Stanford physician, and even I had to wait two months to see a primary care doctor for the first time to establish care,” says Sara Vaughn, a reproductive health specialist and fellow in medicine at Stanford University. For people without insurance, these services could save them money.
Nurx, for instance, which is available in 18 US states, charges as low as $15 for the pill and no prescription fee. In comparison, a doctor’s visit can cost between $35 and $250, according to Planned Parenthood. For patients without insurance, the Pill Club charges $15 for its consultations; after creating an account, you have to answer questions about your health conditions and medical history. A team of nurse practitioners then review that information and write a prescription for either the pill, the ring, or the patch. The medication is then delivered to your door for free.
“I think it has a lot of potential to be really, really quite wonderful and useful,” says Vaughn. “As long as you have appropriate warnings on things, then I think anything that can increase access to contraception is a really good thing.” Vaughn says that about half of pregnancies in the US are unintended, and of those, about half are because people are not using contraception. Unintended pregnancies can lead to abortions, medical complications, and economic problems.
But there are some considerations to keep in mind. It’s important that patients are screened before getting a birth control prescription, Vaughn says. People with certain medical conditions, like breast cancer, shouldn’t be prescribed birth control methods that release hormones to prevent pregnancy. If you have certain types of migraines, called migraines with aura, for instance, taking the pill could increase your risk of stroke, Vaughn says. “That’s sort of the scenario where I think it’d be important for a doctor to be involved in that decision,” she says.
Different birth control methods have different side effects and are used differently. The pill, for example, is very effective at preventing pregnancy, but it does require the patient to remember to take it every day, roughly around the same time. For a mother who’s just had her first child, for instance, that can be stressful. “[It’s] one more thing to remember,” Vaughn says. So, for those types of patients, longer-term birth control methods like IUDs, which are placed in the uterus and work for a few years, can be better.
Sandy Wang, lead nurse practitioner at The Pill Club, says the company has a team of nurse practitioners, registered nurses, and collaborating physicians who provide counseling for customers, informing them about potential side effects, different methods of birth control, and the importance of getting regular checkups. “All our patients have to do is text us and we’ll take care of them with one-on-one conversations,” Wang writes in an email to The Verge.
The Pill Club plans to expand its services to all 50 US states by the end of the year. (Rollout depends on the different state laws.) Meanwhile, a nonprofit organization called Ibis Reproductive Health is trying to get the US Food and Drug Administration to approve an over-the-counter birth control pill so that prescriptions — and an internet connection — aren’t needed at all. “An over-the-counter pill available directly off the shelf would have a much more immediate sweeping impact for people around the country,” says Britt Wahlin, the vice president for development and public affairs at Ibis Reproductive Health.
Many other over-the-counter medications, like Tylenol and Advil, have severe side effects if taken incorrectly. The birth control pill has been around for almost 60 years, and it’s safe, Wahlin tells The Verge. The spread of online prescriptions for contraceptives shows that “we’re really ready for innovation,” she says. “I’m hoping that these online prescriber models and then our work to move a pill over the counter show that we’re really ready to change the playing field in terms of how you access birth control.”