Birth control apps find a big market in 'contraception deserts'

Rachel Ralph works long hours at an accounting firm in Oakland, Calif., and coordinates much of her life via the apps on her phone.

So when she first heard several months ago that she could order her usual brand of birth control pills via an app and have them delivered to her doorstep in a day or two, it seemed perfect. She was working 12-hour days.

"Food was delivered; dinner was often delivered," Ralph says. "Anything I could get sent to my house with little effort — the better." Ralph ordered a three-month supply of pills via the app of a San Francisco-based company called NURX. It's one of several digital ventures, including Maven and Lemonaid Health, that now provide several types of hormonal contraception without requiring a live visit to a doctor or other health care provider.

Women using these services in cities say they like the speed and no-hassle privacy they get by making a purchase through the app. And in some rural areas where women's health clinics are few and far between, being able to buy prescription contraceptives online — starting at around $15 for a month's supply — can be not only much more private, but much more affordable and less time-consuming than driving an hour or more to the closest clinic, or paying for a doctor's appointment.

NURX is now available in 18 states. It's popular in Texas, where many women live in what some health policy analysts call "contraception deserts" — places that lack easy access to women's health services.

The company's process is pretty simple. After users log in to the NURX app, they fill out a questionnaire.

"They tell us about their medical history," says Jessica Horowitz, a nurse practitioner with NURX who consults with patients via online chats. "They give us a blood-pressure check."

A clinician like Horowitz then reviews the answers and, based on that, makes a suggestion about what type of hormonal contraception might be best for that individual; a pill, a ring or a patch are available, as well as emergency contraception. If the patient has a question about the product she's considering, she can send an instant message or call to chat with a provider.

"It doesn't matter what time of day it is," Horowitz says. "Someone responds."

Then NURX sends a prescription to a pharmacy and the drugs are mailed out via priority mail, or faster for emergency contraception. The cost of a month's supply of prescription birth control is often free to patients, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month's supply, depending on the brand.

For Claire Hammons, who lives and works in Llano, Texas, about 90 minutes outside Austin, the low cost of the pills was as important as the convenience.

Hammons loves many aspects of life in her small town. "There is a population of 3,000 people," she says. "But we have a lot going on. We are a huge art town. We have the Llano River. We are surrounded by state parks."

Still, living there has its drawbacks, she says. There's no women's health clinic nearby, and getting prescription contraceptives isn't easy, especially without health insurance. And for Hammons, the main medicine she needs is birth control pills.

"I've been taking birth control since I was 16 because of endometriosis," she explains.

If she can't get the pills, Hammons is in a lot of pain every month. A while back, after losing her health plan, Hammons had a particularly hard time getting a prescription. Her out-of-pocket cost for a doctor's visit in Llano would have been $140.

"I really did not have — literally — have the money to go to the doctor. Period," she says.

Hammons says she also couldn't afford to pay out of pocket to pick up the pills every month at a pharmacy.

Then, about six months ago, she went online and found NURX. The cost-savings, she says, was "really amazing and ... saved me a lot."

Texas has become a big market for the app. Dr. Brook Randal, an emergency medicine physician in Austin who works as a provider for NURX, says her patients come from different backgrounds and use the app for different reasons.

"A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live," she says. "And so we provide an important service for those women."

In 2013, the state passed an abortion bill that led half of all Texas clinics that performed abortions to close — clinics that often also provided birth control and other medical services to low-income women.

"Many of those women will tell us that they would have had to drive a really long distance in order to get to a clinic where they can get birth control economically," Randal says.

And their access to birth control got even worse when Texas lawmakers cut funding for the state's family planning program, says Stacey Pogue, a health policy analyst with the Center for Public Policy Priorities in Austin. The cuts came at a time when the state's population was growing and more women were seeking services, Pogue notes.

"The ability of our safety net system to meet those needs and deliver health care — to actually get health care to women who are looking for contraceptives and well-woman exams — that has certainly been diminished," she says.

Apps like NURX that give women access to at least some types of contraceptives are definitely helpful, she says. But they aren't a comprehensive solution.

Some of the most effective types of birth control — IUDs and implants — aren't available through the apps, Pogue notes, because they require a visit to a health provider. And apps will never substitute for the missing medical clinics — places where, beyond contraception, women could also get life-saving services, such as pap smears, breast exams and cervical cancer screenings.

Texas is one of two states (Indiana is the other) where minors can't buy prescription birth control through NURX because of laws restricting minors' access to contraception.

Lesley McClurg covers mental health and consumer health stories for KQED in San Francisco, Calif. Ashley Lopez reports on health care and politics for KUT, in Austin, Texas. Copyright 2019 NPR. To see more, visit https://www.npr.org.

(2018-03-27 04:00:00 UTC):

In the audio of this story, as in a previous Web version, we incorrectly suggest that Llano, Texas, has only one doctor. In fact, there are about a dozen physicians there, and most of them provide primary care.