CVS Expands Coverage to Include Opill as First Non-Prescription Birth Control Pill

CVS to Cover OTC Birth Control Pill for Free

CVS prescription drug plans will cover the first non-prescription 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.

Background on PBMs

PBMs are the intermediaries in the prescription drug supply chain who 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 OptumRx, 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.
• Perrigo, the pill's manufacturer, applauds Caremark for joining the initiative to increase access to contraceptives like Opill.

Studies have shown that even a small cost barrier could present significant challenges to accessibility. Opill's approval as the first OTC birth control pill in the U.S. has the potential to greatly impact reproductive health, especially for younger women and underserved communities.