Screenshot Nurx

Nurx is one of a growing number of companies selling birth control pills online to deliver to doorsteps in Kentucky. | Screenshot Nurx

By Alex Acquisto | Lexington Herald-Leader

A growing number of companies that sell birth control online and deliver it to doorsteps are operating in Kentucky, a trend that advocates say is enhancing the availability of reproductive health care in underserved areas of the country.

Nurx, a San Francisco-based health technology company founded in 2016, is the latest company to provide an array of prescription contraceptive options and sexually transmitted infection testing kits for purchase on its website or using a mobile app, including birth control pills, patches and rings, the emergency contraceptive Plan B, Human Papillomavirus testing kits, and PrEP, a pre-exposure prophylaxis to prevent HIV infection.

Other companies include HeyDoctor, Lemonaid and The Pill Club.

In the last three years, Nurx has prescribed birth control to more than 400,000 women, 40% of whom live in the southern states including Alabama, Texas, Tennessee and Virginia, a company spokeswoman said. On Tuesday, Kentucky became the 26th state where Nurx services are offered.

Close to 20 million women nationwide and nearly 265,000 women in Kentucky live in contraceptive deserts, which means they don’t have reasonable access to the full range of reproductive health options, according to Power to Decide, a reproductive health care rights advocacy group. Typically what’s considered reasonable is one health care provider for every 1,000 women.

Almost 100,000 Kentucky women live in a county with no reproductive health care clinics. That’s why Nurx CEO Varsha Rao thinks her company’s services are “well-suited to reach people in Kentucky whose needs aren’t currently being met by the health care system.”

“Knowing the need and demand, we’re expecting Kentucky will be one of those states where we see a pretty large influx of patients,” company spokeswoman Allison Berry said.

In recent years, Kentucky has been home to some of the country’s highest teen birth rates, according to the Centers for Disease Control, and swelling numbers of people infected with sexually transmitted diseases, including HPV and chlamydia.

In rural Kentucky, where reproductive health care clinics and providers are more sparse, distance and stigma can play factors in general prescription accessibility, said Marcie Crim, executive director for the Kentucky Health Justice Network.

“If you feel as if you have no privacy in your own community when it comes to making decisions about your body, then having a way to be able to do that can empower people in ways most people don’t understand,” said Crim, whose organization also helps operate All Access EKY, which connects women with local contraceptive and abortion services in 10 Eastern Kentucky counties.

Through a remote telemedicine messaging consultation with a licensed health care provider — if using a smartphone, that could mean texting with a physician and answering a series of health-related questions — and by uploading a copy of one’s ID, eligible patients can pay out of pocket or use insurance to get reproductive products mailed to their home. That includes children as young as 13 years old, according to Nurx’s Terms and Conditions.

If a Nurx patient needs medical attention or is interested in something it doesn’t offer such as an IUD because the contraceptive devices have to be implanted, the company tries to coordinate with local providers for a “soft patient handoff,” said Berry.

The fledgling prescription-by-mail company, referred to by some as the “Uber for birth control,” because its pills can be ordered using a smartphone app, came under fire earlier this year after a New York Times article detailed questionable company practices, including allowing non-licensed employees to handle and mail birth control pills. New company leadership later apologized for the incident.

The use of telemedicine — often a face-to-face consultation via computer with a licensed physician or nurse practitioner — isn’t new, but companies that provide doorstep prescriptions are.

Circumventing the traditional steps of setting up a doctor’s visit and filling a prescription at a nearby pharmacy can save time and money, but the accelerated approach of companies like Nurx can increase the potential for cutting corners, some critics have said.

But by bringing virtually all reproductive medications and testing options short of abortion to one’s doorstep, it could be a game-changer for Kentuckians in need of comprehensive reproductive health care, which has long been hard to come by, Crim said.

“Anything that makes it easier for people to decide their own future in terms of health care, their family, whether or not to have a child or a family now or later, anything that gives people the power to make that decision and see it through is fantastic,” she said.