The Unfulfilled Promise Of On-Demand Birth Control

Big Pharma can make lots more money elsewhere, so contraceptive innovation has lagged

- Naomi Kresge and Cynthia Koons

Since the contraceptive pill transformed women’s lives almost 60 years ago, there’s been precious little innovation in birth control for women. Now a company in San Diego claims to be on the verge of something that could advance the field: a gel women can apply an hour before sex, without having to mess with their hormones. “There hasn’t been innovation in this category in decades,” Evofem Biosciences Inc. Chief Executive Officer Saundra Pelletier says. “It’s time that women have the opportunity to have sex on demand, like men have had with condoms for years.”

That’s a powerful message. But look more closely and Evofem’s product, Amphora, is also a case study in why real advances in birth control are so rare. With plenty of consumer interest in an easier-to-manage female contraceptive, you’d think there’d be many more choices. Yet Amphora is a little-changed version of an over-the-counter lubricant cleared for sale more than a decade ago.

The reason there aren’t more and better options for women is simple: money. In the era of $20 billion blockbusters such as the arthritis drug Humira and $2 million-a-patient gene therapies to treat rare diseases, the pharmaceutical industry doesn’t see a big payoff in rolling out products that don’t have record-breaking potential. Bayer AG’s Yaz family of medicines, one of the best-selling lines of birth control pills, generated about $1.4 billion in revenue at its sales peak. Evofem estimates its birth control gel could top out at just under $1 billion in annual U.S. sales. “Pharmaceutical companies don’t really see the benefit,” says Emma Gargus, who leads contraceptive projects at Northwestern University’s Woodruff research lab.