For the last three years, Mikayla Lloyd has gotten her birth control pills from the student health center on campus at Florida State University. Whenever she needed to pick up a refill, she would stop by the health center on a day she had classes, since, to save money, she lives at home with her family in a small, rural town just outside of Tallahassee. That was her plan when, a few days before spring break, her prescription ran out. But that plan changed when her university notified students that they would be finishing the rest of the school year remotely because of the coronavirus.

Now Lloyd, who is 20, is an hour away from school, and frustrated with how difficult it has been to figure out how to get her next pack of pills.

“I have other medication on top of birth control that I have to take every day,” Lloyd said.

"The difference between how easy it was to fill those prescriptions versus how hard it was to figure out how to fill my birth control prescription was miles apart.”

When government officials issued guidance instructing Americans to self-isolate and social distance as much as possible during the COVID-19 pandemic, they also advised people to stock up on essential medications—cold and fever remedies, blood pressure and diabetes prescriptions, and so on. For people on birth control, this mandate meant navigating a complicated maze to get the medication they need, involving transferring prescriptions to new locations, like Lloyd did; getting an appointment during a time when many doctors are postponing or cancelling them; or figuring out how to pay for the medication after losing their jobs and, therefore, their insurance coverage. This is to say nothing of possible birth control shortages as the pandemic disrupts supply chains, something the Guttmacher Institute warned about in a report published last week.

Because states and insurance companies have different policies on how many months of birth control patients can be prescribed at once, people can’t “stock up” on it the way they might other medications, particularly since birth control isn’t sold over-the-counter—a longtime demand from reproductive health advocates and experts.

“If people can’t leave their homes or are being advised to avoid health clinics unless they’re really sick, this is the moment that highlights why an over-the-counter birth control option would really help people overcome those barriers,” said Britt Wahlin, the vice president for development and public affairs at Ibis Reproductive Health, the research organization behind the “Free the Pill” campaign.

“Being able to get a product off the shelf at the same time as you’re picking up toothpaste, deodorant, or tampons would make access so much easier,” Wahlin said.

Accessing birth control can be difficult even under ordinary circumstances. Typically, getting a prescription for hormonal birth control pills involves patients scheduling an appointment with a primary care physician or gynecologist, discussing the best option for them, and then picking up the medication at a pharmacy. It sounds straightforward enough—but it can take weeks or even months to schedule an appointment with an OB/GYN, and getting to the appointment can be difficult for hourly workers, people with children, and those who rely on public transportation to get around.

Then there’s the cost: A doctor’s visit to get a prescription can cost anywhere from $35 to $250, depending on a patient’s insurance, according to Planned Parenthood. The pills themselves can cost as much as $50 for a single pack, adding up to several hundred of dollars each year. Most insurance plans cover these costs, but some—including those provided by religious employers—do not.

A global pandemic and all of its attendant chaos has only exacerbated these barriers, and made the gaps in our health care system more stark.

Up until last week, Shirley Zhou, 22, relied on her insurance to cover 100 percent of the cost of NuvaRing, the birth control method she’s been using for the last five years. But she doesn’t doesn’t know if she’ll be able to get next month’s ring, or if she’ll have to switch to another form of birth control entirely: She lost her job at a travel-related tech startup on Friday in just one of the hundreds of mass layoffs taking place across the country as a result of the coronavirus.

Though her coverage won’t run out until April 1, her insurance only allows her to get one NuvaRing per month, which means she can’t pick up any extras. When she stopped by her local drugstore post-layoff, the pharmacist told her the NuvaRing would cost $198 without insurance.

“The price makes it seem like a luxury even though it isn’t,” Zhou said. “For me, it’s a necessity.”

Zhou said she’s trying to find an open appointment at a nearby Planned Parenthood clinic, as reproductive health providers sometimes subsidize care for people without insurance.

When she stopped by her local drugstore post-layoff, the pharmacist told her the NuvaRing would cost $198 without insurance.

But in lieu of regular in-person appointments and runs to the pharmacy, many people have been turning to telemedicine apps like Nurx and Pill Club, which allow patients to have remote consultations with licensed physicians and get birth control pills mailed to their door. These services were intended to address common obstacles to birth control access, but they are proving to be even more critical now, in a more unusual situation: A spokesperson for Nurx told VICE that the company has received its highest-ever number of requests in the last few days since it launched in 2016, a trend Nurx expects to continue.

Nick Chang, the founder and CEO of the Pill Club, said the company has noticed a huge uptick in patients transferring prescriptions from local pharmacies to their service.

“This week alone we received about 30 percent more of these types of requests,” Chang said. “Many of our patients have also reached out to make sure that their subscription won’t be disrupted because they’ve had to move and are staying at a different address—a big part of our subscriber base is college students who have been told to return home.”

Students aren’t the only people relocating on short notice due to the pandemic. Katy Costikyan, 23, moved out of her apartment in New York City this week after losing her restaurant job in another coronavirus-related layoff. She had been using Nurx for the last few years, and was relieved knowing that she could transfer her prescription to a rural Pennsylvania address, where she’s isolating with her boyfriend.

“Without the [telemedicine] option, I would have run out of birth control and I don’t know if I would be able to find a new doctor and get a new prescription in person, given the circumstances,” Costikyan said. “My birth control is tied up with my hormones so it would physically have effects on me if I disrupted that cycle. I feel like there are so many stressful things going on right now, I really don’t want to stress about getting pregnant.”

But restrictive telemedicine policies mean services like Nurx can’t operate in every state: Currently, just 29 states and Washington D.C. allow for what’s known as “asynchronous telemedicine,” which means patients and providers don’t have to be online or video chatting at the same time. With asynchronous telemedicine, patients can message their providers at their convenience, and providers can respond when they see the message.

Advocates for reproductive telehealth, as well as over-the-counter birth control, hope lawmakers see that the in-person prescription model isn’t the only safe way to help people access contraceptives—and in fact, it may not even be the most effective one.

"I feel like there are so many stressful things going on right now, I really don’t want to stress about getting pregnant.”

“May will be the 60th anniversary of the FDA approving the first birth control pill so we have decades of research showing it’s safe and effective,” Wahlin said. “There’s no need to have a prescription get in the way of people’s access.”

During a global pandemic, telemedicine would give patients one less thing to worry about, and one less hoop to jump through to make sure they’re staying safe and healthy. And for some people, taking a pill every day is part of their normal routine—and both normalcy and routine feel even more important to them right now.

“Compared to everything else—people getting sick and even dying from the virus—it might seem like a minuscule thing,” Lloyd said. “But your body gets so used to taking it, and it feels like it’s one piece of normalcy that’s been thrown out the window on top of everything else.”

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