To Expand Reproductive Health Care Access, Cadence OTC Went to the Convenience Store

Co-founder Samantha Miller has a simple goal: Make Plan B available everywhere condoms are sold. 

In January 2016, when Samantha Miller persuaded pharmaceutical giant Pfizer to sell her the rights to two of its popular birth control formulations, she wasn’t just closing a deal. She was launching what she and her co-founders at Oakland, California-based Cadence OTC hoped would be a women’s health care revolution: making female contraception as accessible as condoms. Ten years later, you can find the company’s products at more than 17,000 convenience stores in 49 states.

Just a year and a half earlier, Miller had been introduced to two doctors who would change the course of her professional life: Malcolm Potts, a respected reproductive scientist and professor of public health at UC Berkeley, and Nap Hosang, a fellow public health expert and ob-gyn. “For decades, Malcolm had had the dream to bring the most popular form of female contraception, the pill, over the counter,” says Miller, 61. “He approached Nap, and together they tried to make it happen through advocacy—writing letters to the FDA, asking medical associations to get on board. But you can’t do it through advocacy. It’s an industry problem. That’s when they came to me.”

Miller, who holds a master’s in microbiology and immunology as well as an MBA, had a long career negotiating licensing deals between small pharma companies and giants like Pfizer. Much like tech startups, small pharma often generates innovative, niche drugs that big pharma will then usher into manufacturing and distribution. But in cases like the birth control pill, when drug patents have expired and lower-cost generics have taken their place, it can work in the opposite direction: Big pharma may be willing to unload a patent that doesn’t generate much revenue because they’re focused on blockbuster drugs with huge paydays.  

Miller wasn’t looking to take on a new project, but a stat she says Hosang shared with her stopped her cold: More than 40 percent of all pregnancies in the United States are unintended (a number that has held pretty steady since). “I had tickets to a concert that night and I couldn’t concentrate because I kept thinking about the consequences of that,” says Miller. “A poorly timed pregnancy is at the root of the suppression of women in poverty—single moms can’t finish their education and become economically independent. Men don’t have that burden.” An affordable, over-the-counter birth control pill would obviate the need for a doctor’s visit to get a prescription, and help remove barriers like cost, lack of insurance, and limited access for those living in pharmacy and contraceptive “deserts.” 

How Canva Became the Power Player in the AI Design Wars

To switch an existing prescription medication to over-the-counter (OTC) requires first getting the rights to the drug, and then getting the FDA to approve it for OTC use. In this case, the founders wanted to bring the combination estrogen-progestin pill, the most frequently prescribed form of birth control, to market. (A progestin-only pill was approved for OTC in 2023 and is now available under the brand name Opill.) They reached out to four major pharmaceutical companies that owned the rights to these products, asking if they’d sell. Miller knew it was a long shot—and that she was uniquely qualified to take it because she had direct access to pharmaceutical business development and licensing executives. “It seemed like a moment of fate. The next day, I dropped everything and got in contact,” says Miller. 

After about a year of discussions with Pfizer, Miller says the pharma giant agreed to sell Cadence OTC the two formulations for $1 million each. With those in hand, Miller’s team began raising money in earnest, starting with a personal pool of $300,000 from the three founders. Other early investors included social impact venture capital firms, family offices like Abigail Disney’s, the Soros Economic Development Fund, crowdfunds, friends, and family—all of whom believed strongly in the company’s purpose. “We’re a Delaware public benefit corporation, meaning our social mission goals are in our corporate charter, which all of our investors sign on to. It says that our public benefits goals have equal weight as your financial ones,” says Miller. “We want investors to get a return, but they’re not expecting it to be as big as they would had they invested in, say, Microsoft.” This also allows Cadence OTC to operate with smaller margins and keep its products affordable.

Their first big swing, to get the FDA to approve birth control for OTC sale, was taking longer than anticipated. So they shifted their focus to emergency contraception, which was already sold over the counter, but “there was still an access problem because it was available only in pharmacies, was priced very high, and was basically controlled by one company,” says Miller. Stores typically charged $40 to $50, pricing many women out of access to the time-sensitive medication. And with pharmacies and family planning clinics closing across the U.S. in recent years, particularly in rural areas, the access crisis was only deepening. 

© Inc.com