Lessons learned from the movement behind the first over-the-counter daily birth control pill in the United States and recommended strategies for implementing full insurance coverage

July 13, 2023, marked a historic day for contraception access when the Food and Drug Administration (FDA) approved the first-ever daily over-the-counter (OTC) oral contraceptive pill (OCP) in the United States (US). This approval did not happen overnight. It took two decades of research, advocacy, and partnerships led by the Free the Pill coalition (formerly the Oral Contraceptives Over the Counter Working Group). The Free the Pill coalition’s vision for OTC OCPs goes beyond the FDA approval; it also includes efforts to make other types of OCPs available without a prescription in the US and ensure all forms of OTC contraception are fully covered by insurance without a prescription. This paper captures lessons learned from the movement-driven effort leading to the FDA approval of the first OTC daily OCP in the US. It also provides recommendations for how to achieve the coalition’s vision for making OTC OCPs equitably accessible and fully covered by insurance without a prescription. Insights shared in this paper were informed by a series of meetings hosted by the David and Lucile Packard Foundation with key members and partners of the Free the Pill coalition in February 2025, a series of convenings of the Free the Pill OTC Coverage Implementation Collaborative hosted in 2023 and 2024, and over ten years of convenings and collaborative work with state advocates to advance and implement OTC coverage policies.