State-level policy options for expanding coverage and affordability of over-the-counter contraceptives in the United States.

The introduction of over-the-counter (OTC) oral contraceptive pills to the U.S. market has the potential to expand contraceptive access. Still, current federal policy sets up a significant barrier by allowing health insurers to require a medically unnecessary prescription as a condition of covering the drug. State policymakers have explored multiple strategies for eliminating or mitigating the coverage barrier for state residents, including those with state-regulated private insurance, Medicaid, and coverage for public employees and students at public universities and colleges. In this commentary, we explain the scope and limits of state authority, provide examples of state actions to expand coverage and access to OTC contraceptives, and describe major considerations for state officials in designing, implementing, and overseeing new policies. These strategies serve as a roadmap for additional states seeking means to expand access to OTC contraception.