The FDA’s 2023 approval of over-the-counter (OTC) pill as a daily oral contraceptive represents a transformative opportunity to expand contraceptive access. Emerging evidence confirms that OTC pills are reaching groups who face persistent barriers to prescription-based care, including adolescents, uninsured individuals, rural residents, and people of color (Rodriguez et al., 2025; Schaefer et al., 2025). Yet OTC pill’s out-of-pocket cost of approximately $20 per month remains a substantial barrier for these populations (Kaiser Family Foundation, 2024). Coverage for OTC oral contraceptives is inconsistent across Medicaid programs, and no federal mandate requires coverage of nonprescription contraception. Rigorous economic evidence on OTC pill pricing and subsidy strategies is needed to inform equitable policy decisions.

This project will generate equity-centered economic evidence on OTC pill pricing through three integrated research questions. Research Question 1 will estimate the price elasticity of demand for OTC pill using a stated preference survey design, with elasticity estimates stratified by insurance status, age, and race/ethnicity. Research Question 2 will apply these elasticity estimates to model projected changes in OTC pill uptake under alternative pricing scenarios, and convert uptake changes into pregnancies averted using published typical-use failure rates for oral contraceptives. Research Question 3 will conduct a cost–benefit analysis from a public payer perspective that compares subsidy costs against Medicaid savings from averted pregnancies and generates benefit–cost ratios for each pricing strategy across equity-priority populations.

Findings will provide actionable, policy-ready evidence for Medicaid agencies and policymakers seeking to advance equitable, financially sustainable access to OTC pill.