In cities like Dallas, it seems there’s a CVS pharmacy on every corner. So it’s hard to fathom a medical desert where access to doctors and pharmacies is limited and getting birth control can be an ordeal.
Yet that’s what millions of women in Texas face every year, especially in rural areas. According a report issued in 2015 by the Guttmacher Institute, 54 percent of all pregnancies in Texas were unplanned in 2010, costing taxpayers $2.9 billion that year.
"The most effective way to reduce abortion rates is to prevent unintended pregnancy by improving access to consistent, effective and affordable contraception,” according to the American Congress of Obstetricians and Gynecologists.
And that’s exactly what a San Francisco-based startup has done. Nurx took the legwork out of getting a doctor’s prescription and filling that prescription at a pharmacy with its app that delivers birth control to your door.
Patients create a profile in the app and are connected with a doctors in their state who approve their prescription requests. The meds are shipped to their homes in three to five business days.
“We’re doing all the same things that you do at a doctor’s office; we’re just removing the doctor visit because that’s really not necessary,” says the company’s medical director, Dr. Jessica Knox. “We’re removing visiting the pharmacy, too, because that’s actually a large burden for people as well.”
She says there have been concerns about safety when women aren’t required to sit face-to-face with a provider, but she says the company is not cutting any corners.
"The entire process is meeting CDC guidelines as far as the information we collect and the evaluations we do," Knox says. "This is a real medical service. We’re doing our best to provide safe, affordable and accessible care for people.”
Both new and existing birth-control users can take advantage of the app. For those with health insurance, the medicine and shipping are often both free. For uninsured patients, birth control can be purchased for as little as $15 with free shipping. For Texas residents who don’t have health insurance, the company is also giving away a $30 credit for free birth control with the promo code "TEXAS," which users can enter at checkout in the app.
There are a handful of birth-control delivery apps and internet sites like Nurx: Prjkt Ruby and the Pill Club also take care of new prescriptions and mail the prescriptions to you. But the Pill Club isn’t offered in Texas, and Prjkt Ruby only offers five varieties of oral contraceptives and two varieties of emergency contraceptives. Nurx’s has 40 varieties of the pill and plethora of non-oral birth-control options.
According to Buzzfeed, more sites are doing similar things: Maven charges $18 for a 10-minute consultation, Planned Parenthood requires a video consultation and mails a prescription to you, Lemonaid charges $15 for a prescription for a three-month supply, Glow refills existing prescriptions, and PillPack lets you order pills online but requires you to get a prescription elsewhere.
Combining both steps — acquiring a prescription and filling it — seems simple. Why aren’t all the other apps doing it?
“It makes complete sense to combine them, but logistically, it’s way tougher,” Knox says. “We’re responsible for making sure the pharmacy can dispense the medication, or if they have to order it, is it going to ship out in time? There’s the USPS X-factor — is the post office going to lose your package? There’s a lot more variables that can go wrong.”
Nurx works with partner pharmacies in each state. Typically they are small, mom-and-pop outfits that are nonetheless able to fill and ship hundreds of orders every month.
“It’s amazing how efficient pharmacies are,” Knox says.
The app also offers free access to sexual health counseling and doctors who can tailor treatment if there are side effects.
“We offer counseling around birth control: safe use, if they missed a pill. We do more than just prescribe; we do a lot, lot, lot of counseling around sexual health. It’s actually so shocking what it brings up and a constant reminder of how poor our sexual education in this country is,” Knox says.
Within the app, there are various forms of birth control to chose from: combined estrogen-progestin or progestin-only oral tablets, the Nuva ring, injections, the patch and emergency contraception with overnight delivery.
Many women who have tried hormonal birth control know that not every form is a good fit for a person’s lifestyle or body. Some women are especially sensitive to estrogen and can only tolerate progestin. Some women can’t take the pill at all.
“A lot of it is trial and error. We do medication titration. If it’s a bad fit, we’ll help them find a new one,” Knox says.
To get started in the app, a patient uploads a photo of her picture ID so doctors can establish her identity. She's asked to self-report her medical history and risk factors as with any doctor’s visit. She's also asked to self-report blood pressure. The photo helps prevent fraud.
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“We can tell if they’re requesting birth control for someone else,” Knox says.
In Texas, unlike in many other states, minors aren’t allowed to get birth control without the consent of a parent. According to Knox, the app is still working on ways to verify parental consent for underaged women.
The app was released in Texas on June 5. It’s active in 12 states and initially launched in California in January 2016. Despite the fact that it’s so new, it’s already gotten an overwhelming response.
“Ever since we launched in California, we’ve been getting questions from women all [over] the country asking when we’re going to be in their state. We got tons of messages from women in Texas begging us to get there,” Knox says. “We’ve been swamped by Texas requests in the past few weeks — several hundred per week. It’s been incredibly well received.”