The approval of Opill as the first over-the-counter daily oral contraceptive represents a major opportunity to expand contraceptive access, particularly for people who face barriers to clinic-based care. However, early evidence suggests that policy changes alone may not translate into meaningful access. In North Carolina, Medicaid now covers Opill when purchased over the counter, yet utilization remains extremely low. Understanding why this gap exists is essential for ensuring that over-the-counter contraception policies achieve their intended impact.

This project will examine how pharmacy implementation practices, patient awareness and experiences, and health policy environments shape real-world access to Opill in North Carolina. Using a mixed-methods approach, the study will integrate qualitative interviews, pharmacy sales data, surveys of pharmacists, and economic modeling to understand both the supply side (pharmacies and systems) and demand side (people seeking contraception).

First, the research team will identify barriers and facilitators to stocking and dispensing Opill across both chain and independent pharmacies. Second, the study will explore how adolescents, Medicaid beneficiaries, and uninsured individuals understand and experience access to Opill, particularly in rural and underserved areas. Finally, findings will inform a pharmacoeconomic model estimating how different pharmacy implementation and outreach strategies could influence Opill uptake, unintended pregnancy rates, and Medicaid expenditures.

By generating actionable evidence on how over-the-counter contraception policies function in real-world settings, this project will inform pharmacy systems, Medicaid programs, and policymakers working to improve equitable contraceptive access in North Carolina and other states.