Do online platforms for Rx birth control adequately flag contraindications?

Feb 20, 2019

An in-depth analysis examined screening effectiveness as well as further steps to reduce potential complications.

Online platforms that prescribe hormonal birth control in the United States do sufficiently screen for contraindications, according to a study in the Journal of Telemedicine and Telecare.

 “The majority of conditions that were not adequately screened for are rare among women of reproductive age, but adding questions about these conditions would strengthen the screening process,” said lead author Carmela Zuniga, project manager at Ibis Reproductive Health in Cambridge, Massachusetts, which conducted the study.

As of February 2018, there were nine online platforms: HeyDoctor, Lemonaid, Maven, Nurx, Pandia Health, Planned Parenthood Direct, PRJKT RUBY, The Pill Club and Virtuwell.

“As new websites and apps prescribing birth control emerged, we started keeping track of these platforms and created a chart for people to compare different online prescribing services,” Zuniga told Contemporary OB/GYN

The investigators then decided to take a more in-depth look into each platform’s screening questionnaire to understand how questions about medical conditions were being asked and to assess the rigor of each platform’s screening process. A study team member filled out the health history questionnaire for each online platform from the perspective of a patient looking for a progestin-only pill and then again as a patient seeking a combined oral contraceptive pill.

Some platforms limited birth control options to patients over age 35, regardless of smoking status, which contradicts medical guidelines. “Nonsmokers over age 35 can use both types of birth control pills: combined oral contraceptives and progestin-only pills,” she said. “Additionally, women who are over 35 and smoke can safely use progestin-only pills, and should be able to access these or other progestin-only methods.”

Zuniga said previous research indicates that even when performed by a provider, screening for conditions that might put a woman at risk for complications while using the pill is not always perfect, and women can use a simple checklist to self-screen for health conditions that could make pill use less safe or effective. 

“The fact that self-reported medical conditions, such as blood pressure measurements, are sufficient for telemedicine services to prescribe oral contraceptives shows that self-reporting is practical and acceptable,” Zuniga said. “The next step would be to remove the prescription requirement, so that providers would not have to review a patient’s screening questionnaire at all. Removing the prescription requirement would allow individuals to simply use the checklist themselves before selecting and purchasing a birth control pill that is right for them.”

Although the study concluded that telemedicine services conveniently and safely expand contraceptive access, Zuniga acknowledged that barriers still remain, including the extra costs associated with getting a prescription. “These telemedicine services remove the logistical barriers associated with being physically present at a doctor’s office, but some patients still need to pay to have their medical history assessed by a provider and receive a prescription,” she said. 

Zuniga stressed that true access means affordability. “Making birth control pills available over the counter that are covered by insurance and accessible to people of all ages will lessen the financial burdens and make it easier for women to control their health and lives,” she said.