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Power to the People: The Opill®

By Karen L. Kier
Pharmacist on behalf of the ONU Healthwise Team 

John Lennon and the Plastic Ono Band released Power to the People on March 22, 1971. The song hit number 11 on the Billboard Hot 100. 

The FDA on July 13, 2023 gave the power to the people when they approved the first over-the-counter birth control pill. The progestin-only pill contains norgestrel 0.075mg as the active ingredient. The brand name is Opill®. 

The Opill® became available for purchase starting on March 18, 2024 through numerous vendors. It is available at retail stores, online stores, and the manufacturer’s website. You can have it delivered via the mail, DoorDash and curbside pickup. 

The Opill® packet contains 28 tablets individually packaged by day and week. The first 3 rows (weeks) are yellow pills with the active ingredient in the tablets. The white pills in the last row contain inactive ingredients allowing the body to menstruate.

The Opill® is approved for any age between starting menstruation up to menopause. The progestin-only pill can be used in women with migraines, high blood pressure, those breastfeeding, and those over 35 years who use nicotine. These conditions are often a barrier to oral contraceptives containing estrogen and progestin. 

There are very important counseling points for use of a progestin-only pill for preventing pregnancy. The pill must be taken at the same time each day to provide the best protection. If a pill is taken more than 3 hours late, then a barrier method such as condoms must be used for the next 2 days. This includes taking the pill on the late day as well as each day after. This same concept applies if a pill is missed on any day. If an individual taking the Opill® has vomiting or severe diarrhea within 4 hours of taking the pill, they need to use a barrier method of contraception for the next 2 days. 

Other considerations include not taking it within 5 days of emergency contraception such as Plan B One-Step®. The Opill® is not meant for emergency contraception. Certain medications and herbal supplements can interfere with the effectiveness of the progestin-only pill such as drugs for seizures, HIV, tuberculosis or pulmonary hypertension. Herbal products containing St. John’s wort can reduce the effectiveness of the Opill®. The manufacturer recommends talking to a pharmacist, nurse, or physician if questions arise about drug interactions. 

The progestin-only pills range in effectiveness from 91-98% when taken exactly as recommended at the same time every day with no late or missed pills. The Opill® can be started on any day during the cycle, but a barrier method such as condoms needs to be used the first 2 days of starting a pack for the first time. 

Women already taking other forms of oral contraceptives can switch to the over-the-counter formulation by starting Opill® after they finish a 28-day pack of another product  If a woman is taking a combined estrogen/progestin contraceptive for improving acne, a switch to a progestin-only pill is not advised. The single entity pill can make acne worse.

Other side effects include weight gain, breast tenderness, and bleeding between periods known as breakthrough bleeding (spotting). It is best to talk to a healthcare professional if these side effects become overwhelming. The Opill® should not be taken during pregnancy or if pregnancy is suspected nor be administered in women with a history of breast cancer. 

In a KFF survey, 36% of women between the ages of 18-49 reported not being able to get their prescription birth control pills in time for their next cycle. The Opill® provides a mechanism for women to have more convenient access in such cases. In the same survey, only 16% of women would be willing to pay $20.00 per month or more for an over-the-counter product. 

Another potential barrier to the Opill® is the cost. The monthly cost depending on the source is between $18.97 to $19.99. Some online vendors provide a lower monthly cost if you subscribe. The Opill® is discounted if a 3-month or 6-month supply is purchased. A 3-month supply retails at $49.99 and a 6-month supply is $89.99 (about $15.00 per month). 

The Opill® gives women some power to make choices, but it would still be good to talk to your pharmacist or healthcare provider if you have any questions. 

ONU Healthwise is offering flu and COVID-19 vaccines at clinics Monday-Friday from 4:00-6:00 p.m. Please call for more information. 

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