Community pharmacists' public health role in addressing the appropriate use of over-the-counter oral contraception

According to the U.S. Food and Drug Administration (FDA), half of the 6.1 million pregnancies per year in the United States are unintended. Minority and low socioeconomic status (SES) women are at increased risk of unintended pregnancy and face disparities in accessing contraception. On July 13, 2023, the U.S. FDA approved Opill (norgestrel) tablets as the first daily oral contraceptive (OC) approved for nonprescription use in the United States for the prevention of pregnancy. As a progestin-only pill (POP), norgestrel provides a method of oral contraception with minimal side effects and fewer contraindications than prescription-only combination oral contraceptives (COCs). A review of current literature on patient and pharmacist perceptions of prescription COC and over-the-counter (OTC) POP use indicates POPs are regarded as an accessible, affordable, and safe OTC option. In countries allowing nonprescription POPs, multiple benefits have been noted, including improved continuation rates of therapy and increased utilization by at-risk populations such as adolescents and low-SES or uninsured people. Pharmacists are known as the most accessible health care professionals, placing them in an ideal position to serve as a resource for OC information. As nonprescription norgestrel becomes widely available in the United States, pharmacists need to be prepared to educate patients about the similarities and differences among available contraceptive methods. Pharmacists can empower patients, promote autonomy in reproductive health, and ensure safe and appropriate medication use. The approval of nonprescription norgestrel provides pharmacists with new opportunities to expand their public health role in pregnancy prevention efforts across the population.