Dr. Wondosen (Wondi) Samuel, a faculty member in the Center for Applied Research and Evaluation (CARE) Women's Health at East Tennessee State University, has been awarded a competitive research grant from the Society of Family Planning to examine how pricing and public subsidies could improve access to over-the-counter (OTC) oral contraceptives in the United States following the U.S. Food and Drug Administration's landmark approval of the first OTC birth control pill in 2023.
The funded project, "Advancing Equitable Access to Over-the-Counter Oral Pill: Price Elasticity, Subsidy Modeling, and Cost–Benefit Analysis," will provide one of the first comprehensive economic evaluations of policies designed to improve access to OTC oral contraception. The study will generate evidence to help policymakers understand how reducing the out-of-pocket cost of OTC pills through hypothetical Medicaid subsidies or other pricing strategies could increase contraceptive use and improve health equity.
Although the FDA's approval of OTC oral contraceptives marked a major milestone in expanding reproductive health care access, cost remains a significant barrier for many people. OTC birth control pills typically cost about $20 per month, an expense that can be prohibitive for individuals with low incomes. While some Medicaid programs provide coverage for OTC contraception, coverage policies vary widely across states, and no federal requirement guarantees coverage of nonprescription contraceptives.
Dr. Samuel's research will address this important policy gap through three integrated studies. First, the project will estimate how sensitive consumers are to changes in the price of OTC oral contraceptives by measuring the price elasticity of demand across different population groups, including individuals with different insurance coverage, age groups, and racial and ethnic backgrounds. Second, these estimates will be used to model how various subsidy levels and pricing scenarios could affect contraceptive uptake and reduce unintended pregnancies. Finally, the project will conduct a cost-benefit analysis from the Medicaid perspective to determine whether the costs of subsidizing OTC contraception are offset by savings from preventing Medicaid-funded pregnancies and births.
The findings will provide Medicaid agencies, state policymakers, and other public health decision-makers with policy-ready evidence on the expected health and economic impact of different subsidy strategies. By identifying pricing approaches that maximize both affordability and public value, the project aims to support more equitable and financially sustainable access to contraception, particularly for populations that continue to face barriers to reproductive health care.
"This research will help answer an important policy question: How much could reducing the price of OTC birth control increase access, and would those investments ultimately save public dollars?" said Dr. Samuel. "By combining economic modeling with health policy analysis, we hope to provide evidence that helps Medicaid programs design effective and equitable coverage strategies."
The grant competition was highly competitive, with proposals evaluated for scientific merit, innovation, and potential policy impact. The award builds on Dr. Samuel's previous Society of Family Planning Changemakers in Family Planning grant and expands his ongoing collaboration with the Center for Women's Health at Oregon Health & Science University.
Dr. Samuel is a health economist whose research focuses on health policy, reproductive health, Medicaid, economic evaluation, and the application of causal inference and health economics to improve population health and reduce health disparities. His work has informed family planning policies and Medicaid programs, with a particular emphasis on expanding equitable access to reproductive health services through evidence-based policy analysis.