The Opill^®: a nationwide secret shopper study

FDA approval of the over-the-counter Opill^® presents a significant opportunity to expand access to contraception in the United States. We aimed to assess the Opill's® availability, affordability, and accuracy of pharmacist provided information nationwide, hypothesising that pharmacies located in states with higher abortion restrictions and smaller populations would have less availability and more inaccurate counselling.

Utilising secret shopper methodology, we called pharmacies representing 530 randomly selected cities based on a modified version of the Guttmacher abortion restriction metric which classified states into three categories. Pharmacies were equally distributed between cities with populations above and below 50,000. Pharmacists were asked about availability, cost, and differentiation from abortive medications. Data was analysed by restriction category and population size using Chi-square (or Fischer's exact) tests.

The cohort included 513 pharmacies, with the distribution proportionate to the number of states in each abortion restriction category and evenly distributed by population size. Overall, the Opill® was available in 65% of pharmacies and 47% reported a cost of under $20 per month. There were no significant differences in availability or cost by abortion restriction category, however, pharmacies in areas with <50,000 people were less likely to have the Opill® available (56% vs 73%) and reported higher costs than pharmacies with ≥50,000 population size (both p < 0.01).

This study found that two thirds of pharmacies had the Opill® available but access was significantly reduced in less populated areas; however, this did not seem to be affected by state level abortion restrictions.