Why do Birth Control Pills Only Come in 28-Day Packs?

Now that more women are using hormonal birth control in all forms, including pills, why is it not made available in a bottle? I have to refill my prescription every three weeks because I only get 21 pills in the current packaging that caters to use for birth control, not hormone replacement therapy. And my insurance (and, it appears, most insurances) won’t allow me to purchase more than one packet at a time. Is the pharmaceutical industry going to catch up and package for wider types of use?

—Living at Rite Aid

This is a very frustrating situation indeed! The only way to get a pill that combines estrogen and progesterone in the doses used for contraception is in a 28-day pack that includes four to seven sugar pills. Meanwhile, many women skip the sugar pills and continue straight on to the next pack, thus a given pack of pills will last her only 21 or 24 days, depending on the type of pill.

If you take all 28 pills, you need 13 packs of pills per year. If your pill pack has 21 active pills, you will need roughly 17.4 packs per year. Not only is that more than four packs of extra pills your insurance may not pay for, it is also four or five extra trips to the drugstore to retrieve them. This greatly increases the chances that you will miss pills here and there and have breakthrough bleeding.

There are reasons why some types of medications come in blister packs like those that birth control pills come in. Some medications need to be protected from moisture in the environment, and blister packs are a great way to do that. However, I was unable to find any indication that this is the case for birth control pills. Essentially, the blister pack is to help a woman remember whether she has taken a pill on a given day and to help keep track of the timing of the placebo pills.

More and more, prescription drug manufacturers sell prescriptions in blister packs or bottles that contain a one-month supply. This is easier for the pharmacist, who simply has to pop a bottle or packet of pills into a bag. It is also safer for the patient, who knows they are getting the right medication when it comes in a bottle sealed and labeled by the manufacturer.

There is another reason I think bottles of birth control pills are likely to be in our future. Technically, prescribing birth control pills to be taken without the sugar pills is an off-label use of the medication, albeit a completely safe and common way to use them. As a result, the manufacturer would have to have the labeling changed by the FDA in order to manufacture a 28- or 30-day supply of birth control pills that does not contain the sugar pills. Nearly every birth control pill is available as a generic, so there are few big pharmaceutical companies invested in paying for the studies needed to change the labeling.

Most insurance companies will allow you to get a three-month supply via their mail-order pharmacy. That might be worth looking into — at least it saves you trips to the pharmacy. And you should be able to use your pre-tax health savings account (HSA) to pay for the extra pills.

The takeaway: It is an added expense to take birth control pills continuously, but packaging them differently would likely require a change in the labeling filed with the FDA, and that is unlikely to happen. Your best bet is to see if you can get a three-month supply via the mail-order pharmacy connected to your insurance and use your HSA funds to pay for the extra pills.