Opill is the first daily oral contraceptive to be available over-the-counter (OTC) without a prescription in the United States and has the potential to significantly expand access to oral contraception for millions of Americans by reducing common barriers to access. However, despite research suggesting widespread interest in OTC contraception and Opill product availability since March 2024, uptake remains low, likely due to a variety of barriers, including cost and implementation factors at retail stores that limit availability, accessibility, and awareness. Research is needed on implementation effectiveness and care delivery, particularly research characterizing “Big P” (e.g., insurance coverage, cost-sharing) and “Little P” (e.g., availability, accessibility, price) implementation factors that may impact uptake of OTC oral contraception for populations that have historically faced barriers to accessing contraceptive care (e.g., individuals living in rural areas).

To fill these critical gaps in knowledge, the current multilevel study seeks to characterize implementation of OTC oral contraception policies across states and identify promising, modifiable implementation strategies that could enhance uptake and access. We will use national retail sales and administrative claims data to describe trends in uptake of Opill, including differences by state policy environment, and will conduct a state-wide secret shopper study in Pennsylvania community pharmacies to describe availability of Opill (i.e., access and supply) and pharmacy team members’ awareness of and attitudes about OTC oral contraception. The goal of this project is to produce actionable evidence across multiple levels of implementation of OTC oral contraception to inform recommendations for ongoing national uptake.