In the U.S., the future of reproductive health care has become increasingly uncertain: the traditional ways through which people have been able to access contraception—such as The Pill—have become fodder for political debate, and are resultingly tenuous.
In the absence of clinics like Planned Parenthood, or adequate health insurance coverage with which one could visit a gynecologist or general practitioner, the disparity in access will only continue to widen.
In the scope of reproductive health care, inquiry into alternative means to procure birth control via the internet isn’t new, but it’s certainly becoming increasingly germane. Generally speaking, obtaining birth control in the U.S. involves—at the very least—a visit to a clinic or doctor’s office for a discussion and, ultimately, a prescription. Birth control may or may not be covered by insurance, and if someone needs to pay out of pocket, most pharmaceutical companies manufacture generic versions, which are more affordable (though affordability is highly relative).
But what if you didn’t have to go to the doctor’s office or your neighborhood Planned Parenthood at all? What if you didn’t even have to leave your house to initiate the process? In the last few years, a surge of companies offering birth control through the internet have cropped up with the incentive of convenience—but now that access is being challenged, these companies may find themselves setting a new standard of reproductive health care in the U.S.
For those whose natural inclination is to balk at the idea of navigating prescription drug acquisition via internet, rest assured that a little skepticism is healthy. Birth control may enjoy less of a social stigma than it once did, but it’s still a medication and shouldn’t be viewed so casually as to overlook its risks. If you’re considering procuring birth control online, exercising some common sense caution as an informed patient is integral not just to the efficacy of your birth control choice, but your safety.
In the U.S., the Centers for Disease Control and Prevention and the American College of Gynecologists issue guidelines for medical professionals when it comes to prescribing birth control to patients. There are certain health conditions and lifestyle factors that could make certain types of birth control unsafe for a person to take. The purpose of going to a clinic or your doctor’s office to get a birth control prescription is not just finding the right form of birth control to fit your needs and preferences, but also to determine if there are forms that are unsafe for you to take.
If you’re thinking about procuring birth control on the internet, then, it’s vital to work with a company that prefaces sales with an evaluation. Whether it be via questionnaire, or a Skype call with a physician, some form of medical assessment should be required before you can make a purchase.
One company, Nurx, lets consumers in California, New York, DC, Washington state, Pennsylvania, Virginia and Illinois pick from a wide variety of birth control options, including many forms of The Pill (familiar names like Loestrin, Ortho Try-Cyclen, Yaz, Tri-Sprintec and more). When you make a selection, the product page gives you a breakdown of who the pill is not suitable for. Most types of oral birth control pills are generally not prescribed to women who are breastfeeding, are heavy smokers, have had a blood clot or are at increased risk for blood clots, or are at increased risk for strokes and heart attacks.
Nurx then sends your information to a physician they’ve partnered with who is licensed to practice in your state (if you’re in one of the states mentioned above). They evaluate your choice for efficacy and safety. If approved, the birth control can be paid for out of pocket or with insurance, and the prescriptions can be written for one year. Nurx sources the birth control from a pharmacy near you and mails them out—usually three months’ worth at a time.
Another company, Prjkt Ruby, also prefaces your purchase with a medical questionnaire. These questionnaires should always ask you for your blood pressure reading, as this is an important vital sign for assessing your risk for stroke. If you haven’t had a recent physical, most pharmacies have machines that can read your blood pressure for no cost. Like with Nurx, the medical information you provide to Prjkt Ruby is reviewed by a physician who will decide if a prescription can be issued. If you’re in Virginia, Missouri and Oklahoma, you are also required to have a telemedicine consult with a physician. Prjkt Ruby doesn’t take health insurance, but the birth control they offer is $20 across the board for a three-month supply, making it one of the more affordable options out there if you’re paying out of pocket.
Beyond birth control pills, a company called Lemonaid Health offers a slew of prescription medications for everything from urinary tract infections to acne. The process—while conducted remotely (and via their app) through telemedicine—is more involved than some of the other options, but is commensurate to the service they offer: you pay a $15 consultation fee, answer a medical questionnaire and have a doctor review your information (which may include a telephone call).
Because states have differing laws regarding telemedicine, depending on where you live, Lemonaid’s requirements for consultation will be different: in California, Florida, Illinois, Michigan, Pennsylvania and New York, you don’t need to have a telemedicine consult, you just answer the questionnaire. But in Arizona, Connecticut, Georgia, Ohio, Oregon, Rhode Island or Virginia, you’re required to have a short video call with the physician reviewing your questionnaire.
The ability to procure prescriptions online, birth control or otherwise, is not uniformly available throughout the U.S. because states independently regulate various aspects of the process, and partnering physicians are not licensed to practice in every state. As the demand of these services increases, either due to strain on or decreasing availability of traditional means, these companies may find that they are at the apex of the reproductive health care revolution—one that, for many, can’t come soon enough.
Abby Norman is writer based in New England. She’s currently working on a memoir for Nation Books and is the weekend science editor at Futurism. Her work has been featured in The Rumpus, Atlas Obscura, The Establishment, Cosmopolitan, Seventeen, Medium, The Independent, and others. She’s represented by Tisse Takagi in New York City.