7 Things You Need To Know About Opill, the First OTC Birth Control Pill

From doctor’s appointments to prescriptions to cost barriers, getting reliable, effective contraception hasn’t always been an easy process. But all that is changing today, as Opill—the first over-the-counter (OTC) birth control pill—begins hitting shelves at stores across the country.

The pill is one of the most popular forms of contraception and has been used by millions of people for over 60 years, since the Food & Drug Administration (FDA) first approved oral contraception in 1960. Last year, in a momentous move, the FDA approved Opill as the first birth control pill for use without a prescription.

This marked a historic advancement in access to contraception, allowing more people to take control of their reproductive and sexual health. 

As the colorful boxes become widely available both in stores and online, it’s important to understand how Opill works, who can use it, where to find it, and what to expect when you take it. Let’s dive into the top seven things you need to know before you pick up Opill.

1. Opill is a “mini pill”

Opill is a daily progestin-only birth control pill that prevents pregnancy primarily by thickening cervical mucus, making it harder for the sperm and egg to meet.It works a bit differently from combined hormonal birth control pills that contain both progestin and estrogen, which also typically stop ovulation altogether.

Progestin-only pills, also called the mini pill, need to be taken at the same time every day to be effective at preventing pregnancy.

2. It’s safe for many people, but it’s not right for everyone

Opill, like other progestin-only pills, is a safe and effective birth control pill that can be taken by most people who can get pregnant. When used as directed, Opill is 98 percent effective at preventing pregnancy (just a tad less than combined hormonal birth control pills). 

You shouldn’t use Opill or any other brand of mini pill if you currently have breast cancer. Likewise, talk to your health care provider before using the mini pill if you have any of the following:

• A history of cancer
• Unexplained vaginal bleeding
• Liver disease or a liver tumor
• A history of bariatric surgery
• Lupus

Also talk to your provider about whether the mini-pill is safe for you if you’re taking anticonvulsant drugs, like seizure medications.

3. You can buy it in stores or online

By mid-April, Opill will be on store shelves at all major retailers, including drug stores, pharmacies, and convenience stores across the U.S. and its territories. You will not need a prescription to get Opill, meaning you can purchase it just like you would a bottle of Tylenol or tube of sunscreen. However, some stores and retailers may choose to lock up Opill, meaning you may have to talk to someone who works there to have it unlocked. 

Additionally, you can order Opill online from most major retailers as well as directly from the maker, pharmaceutical company Perrigo.

4. The cost might vary depending on where you buy it

The suggested retail price of Opill is $19.99 for a one-month supply, $49.99 ($16.66/month) for a three-month supply, and $89.99 ($14.99/month) for a six-month supply (this latter option will be available online only). However, it will be up to individual retailers to set their price, which may vary across stores and locations. 

If you need help affording the pill, visit OpillCAP.com to learn more about Opill’s cost assistance program, which provides the pill at low or no cost to people who qualify. Even if you’re not eligible for the program, anyone can get a 5 percent discount on the pill when they sign up for subscription delivery on Opill.com.

5. You can easily swap Opill for your current method of birth control

That’s right—you can switch from another method of birth control (hormonal or not) to Opill right away. You may have to use a backup method of birth control (like condoms) for a couple days, though, depending on which method you’re using right now and how consistent you’ve been. 

If you’re currently using a hormonal method (for example, other brands of birth control pills) and have been consistently using that method, you can start taking Opill the day you get it and stop taking your old pill. If you’re switching from a combination pill to Opill, you’ll want to make sure you switch during your active weeks, not your placebo week. If you switch during your placebo week, you’ll have to use a backup method for 48 hours after starting Opill.  

If you’re on a nonhormonal method of birth control, haven’t been using your hormonal method consistently, or are currently not on any birth control, you’ll need to use a backup method of birth control for 48 hours after starting Opill. 

6. You might have side effects

Just like other brands of the mini pill, some people may experience side effects on Opill. These may include bleeding changes, sore breasts, nausea, acne, or a change in your sex drive. 

Opill is a four-week active pill pack, so you will not have a withdrawal bleed during the placebo week, like with the combination pill. You may have intermittent spotting, though, which is normal.

7. Consistency is key

It’s important to take Opill at the same time every day or within a three-hour window of that time for it to be effective at preventing pregnancy. So, say you take your pill at 8 a.m. every day; if the next day you take it after 11 a.m., you’ll have to use a backup birth control method for 48 hours (while continuing to take Opill as directed). 

In other words, if you are three or more hours late for your pill or miss a pill at any time, use a backup method like a condom if you have sex in the next two days.

The takeaway

Opill is the first step in bridging the gap in people’s access to contraception and their ability to take control of their reproductive health journey.

But while it’s a total game-changer that birth control pills are now available OTC, Opill might not be right for everyone. For most people, birth control is a journey, and no one method is going to work for everyone all the time. People often go through several methods over the course of their life, and having knowledge about and access to many methods is critical to finding a birth control method you love. 

If you have any questions about Opill or aren’t sure if it’s right for you, talk to your OB/GYN or primary care provider.

Raegan McDonald-Mosley, MD, MPH, is a board-certified OB/GYN and the CEO of Power to Decide, an organization with a mission to advance sexual and reproductive well-being for all.