Rachel Ralph works long hours at an accounting firm in Oakland, CA, 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 healthcare 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 they’re considering, they can send an instant message or call to chat with a provider.
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 the patient, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month’s supply, depending on the brand.
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.
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. 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.
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.
