In January, Nurx, an on-demand birth control delivery app, launched a provocative ad campaign on its social channels. The San Francisco startup posted an image of a Trump-like figure dutifully documenting his New Year’s resolutions:
- Make America great again.
- Repeal Obamacare.
- Control women’s bodies.
- Tweet about it.
At the bottom of the ad, Nurx offered $45 in credits for new users with the promo code TINYHANDS.
It was a hit. The tongue-in-cheek ad was repeatedly retweeted and shared by fans, as well as picked up by mainstream news outlets.
The surge in interest reflects fear that the Trump administration and Republican lawmakers will reduce access to birth control, says Jessica Knox, medical director at Nurx. “[Our company] is concerned about the political climate and what it means for patients and people all over the country,” Knox explains to Fast Company. “This ad campaign has been a response to that. It’s designed to be catchy and shareable.”
Nurx saw an immediate impact from the ads, which also included a play on “alternative facts,” Trump adviser Kellyanne Conway’s term that went viral, and a depiction of Trump as the Grinch stealing birth control from under a Christmas tree. The humorous approach propelled the startup into new circles of people. “People like what they see represented in the ads,” confirms Knox. “It’s translated into more patients.”
Nurx is a niche telemedicine service focused on improving access to preventative medicine. That includes consultations and prescriptions for birth control pills, patches, rings, and emergency contraception. It also offers the HIV prevention medication Truvada. Patients submit a medical questionnaire, which is reviewed by a NURX health care provider who then submits the prescription to partner pharmacies for quick fulfillment and delivery. It’s been called “Uber for the uterus.”
“Our founders [Hans Gangeskar and Edvard Engesaeth] felt that these medications are basic, safe preventive medication that people should be able to access really easily and our medical system, as is, usually makes it somewhat challenging to get,” explains Knox. Many young women don’t have the time, flexibility, or desire to visit a doctor annually, which, says Knox, is not a necessity for most healthy women. Currently, 15% of women aged 15-44 depend on the pill, while 7.2% use long-acting reversible contraception, like IUDs, according to the National Center for Health Statistics.
“We’re talking about a medication that, in many countries, you can buy over the counter [without a prescription],” stresses Knox. While it will be a long, arduous process for the U.S. to get to that point, Nurx is ”trying to bridge that gap.”
In short, Nurx simplifies the process. It’s an appealing option for women on the go or who don’t live near a doctor or work long hours. But while women traditionally used the service out of convenience, now many are turning to it out of fear that their current health care routine might be shattered under new federal and state policies—that their access to birth control might be restricted, prescription prices increased, insurance co-pays reinstated.
Since late fall, patients have inundated Nurx’s inboxes with questions about how their access to birth control might change under the Trump administration. During his campaign, President Trump, along with Republican lawmakers, vowed to defund Planned Parenthood because the organization helps a small percentage of patients get abortions. Contraception accounts for 34% of Planned Parenthood’s services, according to the U.S. Government Accountability Office.
“We’ve been getting messages from renewing patients and new patients that are really concerned that they are going to lose access to their birth control,” says Knox. “We’ve had many patients ask how they can stockpile their birth control or Plan B, which unfortunately is not something we can usually help with.”
If patients are paying out of pocket, they can buy 12 months’ worth of contraception, although insurance reimbursement usually limits it to three months. Should a patient lack health insurance, they can pay out of pocket for NURX, which starts at $15 a pack. It can go all the way up to $200, depending on the type of preferred contraception.
Planned Parenthood has also seen an “unprecedented surge” in visitors, both online and at health centers, reports Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America. Planned Parenthood is the largest provider of reproductive health services in the country, with over 650 affiliate health centers. These centers saw a significant increase in appointments for birth control, with a nearly ten-fold increase in people seeking IUDs.
“These spikes illustrate just how important the Affordable Care Act’s birth control benefit has been for women to access the birth control method of their choice,” said McDonald-Mosley in a statement. “The Affordable Care Act has had a huge impact on millions of people, particularly people of color, who often face systemic barriers to health care.”
On Friday, the Senate confirmed the nomination of Representative Tom Price as Secretary of Health and Human Services. Price has been a vocal critic of the Affordable Care Act. If dismantled, it would retract no co-pay fees for birth control for over 55 million American women.
“There’s not one woman” [who doesn’t have access to birth control],” Price famously stated in 2012. But according to Planned Parenthood, that’s simply not true: One in three women struggles to afford prescription birth control, their research finds. And 20 million women needed publicly funded family planning services like birth control in the last year, an increase of 1 million since 2010.
For example, without coverage, out-of-pocket costs for IUDs can range from $500 to $1,000, a prohibitive expense for women with lower incomes.
So, should women be concerned? What changes are expected when it comes to access to contraception? Knox believes that while the current administration’s rhetoric is certainly troubling, it’s too soon to predict how it will limit women’s reproductive health care choices.
“Mostly it’s fear,” she says of the current political climate, “we haven’t actually seen any changes politically that, right now, impact our patients.” However, if the birth control mandate was to be rolled back, prices for patients would likely increase. Insurers might not have to cover birth control completely, resulting in the re-introduction of a co-pay. And since prices are based on what pharmacies are able to get wholesale, a spike would trickle down to patients.
“People will still be able to get birth control, but the accessibility as far as it being affordable might change, and that’s what I’m concerned about.”
That very same concern is what propels Paul Johnson, cofounder and CEO of Lemonaid Health. The San Francisco telemedicine startup provides cost-effective health care, including UTI treatment, to 14 states via app and website. Johnson, who hails from the U.K., saw a U.S. system lacking in ease and transparency—an issue he only sees worsening with the current administration. It’s what troubles incoming patients as well.
“We’re seeing an increase in demand,” says Johnson, who reports a 30% increase in signups since the inauguration. “People are getting more anxious about whether they might be able to continue to get access to cost-effective health care, and we want to be one of the solutions.”
In fact, his current patients are concerned as to whether services such as Lemonaid will be hit by incoming policy changes. “Numerous patients ask whether we’ll still be around in the future,” he says. (To that, he responds, yes, it will). Others, however, have more unreasonable concerns: “A lot of patients ask if they can get 10 years’ worth of birth control pills.” These questions are indicative of the anxiety gripping many American women.
Apart from tending to his consumers’ increasing concerns, Johnson is also worried about how the administration’s policies will affect the health care industry—from a business perspective; that healthcare will “become more of a marketplace, even more than it is at the moment,” he says. Health care could become more expensive and access more limited. These are the challenges he and his team are now addressing.
“We’ve had some of our busiest days,” says Johnson.
The Pill Club is another popular birth control telemedicine service, but the difference is that it’s also a licensed California pharmacy. The company can automatically fulfill and dispense prescriptions—pills, rings, patches, and emergency contraception—then send them out to patients with delivery free of charge. (Packages often come with little treats, like Ghirardelli chocolates or samples of organic lube: It’s a full-service delivery).
The startup reports a dramatic uptick on various fronts—prescriptions, RX fulfillments—since mid-December, when women’s reproductive health became a focal point of the election. The Pill Club’s customer service team has been inundated with questions on coverage and co-pays, concerns the company hopes to clear up.
“We’re trying to really help patients to understand what if Planned Parenthood can’t accept Medicaid or federal reimbursement, there are other options,” says founder Nick Chang. “They can come to us, we can help them.”
The Pill Club sends prescriptions to 10 states, but in lieu of the current political climate, the startup hopes to reach all 50 states by the end of year. It’s an uphill battle as telemedicine regulations vary state-by-state, but Chang feels it’s imperative to expand their services. This is especially important for products such as emergency contraceptive, which is not readily available in certain areas of the country even now. The assumption is that it will only become more challenging.
As Chang noted, ”there are a bunch of cool companies right now, including us, trying to provide access in ways that you won’t have to fear or worry about the stigma or having to pay a lot out of pocket.”
It’s a sentiment echoed by Knox, who envisions Nurx—in addition to other like-minded companies—calming American women’s fears. By getting the word out, often in innovative ways, these startups believe they can fight back against what might be coming down the line.
“We’re trying to meet people where they are and make them feel comfortable, instead of trying to make them jump through hoops,” says Knox. “We’re definitely in a time where our services can be well used.”