California Bill AB 50 Introduced to Create More Equitable Contraceptive Access in California

Measure seeks to remove barriers to over-the-counter birth control for Medi-Cal enrollees

Sacramento, CA – Today, AB 50 was introduced by Assemblymember Mia Bonta to address inequities in over-the-counter birth control access, including the first-ever FDA-approved over-the-counter birth control pill Opill, for individuals insured through Medi-Cal. AB 50 is co-sponsored by Essential Access Health, Birth Control Pharmacist, and the National Health Law Program (NHeLP).

“California is a leader in enacting comprehensive and inclusive contraceptive coverage requirements, but work remains to guarantee equitable access to the full range of birth control methods for all Californians,” said Amy Moy, Co-CEO of Essential Access Health. “Action is needed to ensure that Medi-Cal enrollees have the same contraceptive access as people with private health insurance. AB 50 will close a loophole to allow people with Medi-Cal coverage to get over-the-counter methods, including the birth control pill, Opill, without a prescription or out-of -pocket costs. As we face an incoming Administration and Congress hostile to reproductive freedom, it’s imperative and time-sensitive for the state to take every step possible to create a more just and equitable health care system for all Californians. We thank Assemblymember Bonta for being a health equity champion and for her leadership on this important measure.”

“Over-the-counter birth control is ensuring contraceptives are readily available to more people than ever. We should not stifle this progress by leaving Medi-Cal recipients behind and making low-income communities have to take more steps than their peers on private insurance to access medication,” said Assemblymember Mia Bonta. “AB 50 will ensure equity and fairness by removing these hoops for those on Medi-Cal.”

In January, 2024, the Contraceptive Equity Act of 2022 (SB 523, Leyva) took effect, which requires public and private health insurance coverage of OTC birth control methods without cost-sharing or a prescription. As a result, Californians covered by private health insurance should be able to access OTC birth control, including Opill, without a prescription or out-of-pocket costs at their local pharmacy right now.

However, when a Medi-Cal enrollee wants to obtain coverage of OTC birth control, they have to go through the same procedures as if they were obtaining a prescription-only contraceptive at the pharmacy. This includes finding a pharmacy with pharmacists that have received required training to furnish self-administered hormonal birth control methods like the full range of birth control pills, the patch, and ring, without a prescription, filling out a self-screening questionnaire, and receiving counseling – all to simply access birth control that is approved to be accessible OTC. These policies make OTC access without cost-sharing out of reach for millions of Californians enrolled in Medi-Cal.

AB 50 makes clear that a pharmacist may furnish over-the-counter birth control without the standardized procedures that are required for prescription-only self-administered birth control, removing undue burdens on the patient and pharmacy. By doing so, the bill will expand equitable access to OTC birth control regardless of health insurance coverage. 

“California continues to lead the way by recognizing pharmacies and pharmacists as an essential access point for reproductive health services and products,” said Dr. Sally Rafie, Founder of Birth Control Pharmacist. “With this simple policy change, pharmacists will be able to help people use their health insurance to obtain over-the-counter birth control at no cost. This legislation will enable Californians to access safe and effective medications to maintain their health and achieve their life goals.”

OTC birth control is a valuable tool to expand access, particularly for communities facing systemic barriers to care, including people living in rural areas who must travel long distances to the nearest health care provider, individuals with transportation challenges, and those with limited or no paid time off for medical appointments.

A 2023 study by the UCLA Center on Reproductive Health, Law and Policy of cisgender heterosexual and bisexual California women ages 18-44 found that approximately 3.8 million women in California are sexually active and do not intend to get pregnant, but a quarter were not using any form of contraception. Women with lower incomes were less likely to use contraception than those with higher incomes, and women of color were also significantly less likely to use contraception than their white counterparts — likely due to persistent barriers including out-of-pocket costs; misinformation and misperceptions about contraceptives, and lacking a usual source of health care.

AB 50 provides a clear and practical policy solution to fix a systemic barrier to birth control by ensuring equitable access to OTC methods in communities statewide.

“If enacted, this bill will advance health equity by making it easier for people, including those enrolled in Medi-Cal, to access over-the-counter contraceptives,” said Christina Piecora, Senior Policy Analyst at the National Health Law Program. “The National Health Law Program is proud to join our partners Essential Access Health and Birth Control Pharmacist in co-sponsoring this important bill removing burdensome and unnecessary self-screening and assessment protocols for pharmacists furnishing over-the-counter contraceptives. We commend Assemblymember Bonta for introducing this bill and stand ready to work with her in taking the next big step toward contraceptive equity in the state.”

Essential Access Health (Essential Access) is a trusted leader on birth control coverage and access policies. In addition to sponsoring the Contraceptive Equity Act of 2022, Essential Access previously sponsored legislation that requires health plans to cover a 12-month supply of self-administered birth control, requires plans to provide access to the full range of FDA-approved birth control methods without cost-sharing, delays or denials, and allows registered nurses to dispense hormonal birth control.

Essential Access has also administered the federal family planning program Title X in California since 1970 when the program was established and in Hawai’i since 2022, and currently distributes funding to and supports nearly 400 health care delivery sites across both states collectively serving more than 460,000 people. 

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