By Emily A. Eckert, Community Health Organizer
Happy National Women’s Health Week! National Women’s Health Week is an observance led by the U.S. Department of Health and Human Services Office on Women’s Health. To celebrate this weeklong, nationwide event, the Pennsylvania Health Access Network (PHAN) is issuing a three-part educational blog series focusing on health policy topics of particular interest to women.
Women gained a number of protections with the passage of the Affordable Care Act (ACA), including the guaranteed coverage of preventive services with no out-of-pocket costs. These preventive services include well-woman visits, breastfeeding support, and HIV screening and counseling, among others. Also included in the list of preventive services for women is access to all FDA-approved birth control methods. This provision is especially important to women’s health as 99% of sexually active women have used birth control at some point in their lives.
The birth control benefit took effect in 2012, allowing more than 48 million women to access the family planning method of their choice without financial burden. This provision is a huge victory for women, virtually eliminating one of the largest barriers to accessing care. In 2013, women saved more than $483 million in out-of-pocket costs for birth control. Despite the specificity of the law, there are serious variations in how insurance carriers are interpreting the federal guidelines for contraceptive coverage. This variation means that not all women are truly experiencing the health care benefits they are entitled to.
Healthcare.gov specifies that insurance plans must cover all FDA-approved birth control methods, including barrier methods, hormonal methods, implanted devices, emergency contraception, sterilization procedures, and patient education and counseling. A recent study by the Kaiser Family Foundation (KFF) found that some methods are more favorable for coverage than others, with vaginal rings, implants, patches, and intrauterine devices (IUD) being covered the least. A report from the National Women’s Law Center (NWLC) confirms these findings, and further concludes that a number of insurance companies limit their coverage to generic drugs and devices only.
With twenty FDA-approved methods of birth control, women have the ability to consult with their doctors and choose the method that works best for their lifestyle. Not all women can remember to take a once-daily pill, just as other women are not interested in long-acting reversible contraception (LARCs). Failure to cover all FDA-approved contraceptives—and the imposition of out-of-pocket costs for certain methods— directly interrupts the health decisions made between a woman and her doctor.
Similarly, limiting coverage to generic methods is often a direct violation of the patient protections signed into law under the ACA. This is problematic because several birth control methods do not currently have a generic option, like the copper IUD. Additionally, there are a number of oral methods for which there is no generic equivalent. In cases where there is no comparable generic, the ACA requires insurance plans to cover the brand-name drug without cost sharing. The National Women’s Law Center study has found that instead of obeying the law, many insurance companies make recommendations to women to simply change their birth control method to one of the covered options.
The violations documented by the Kaiser Family Foundation and the National Women’s Law Center validate that many women are struggling to access birth control without cost sharing. To amend any misinterpretation of these laws, the Obama administration recently released additional guidance about what preventive services must be covered without copayments. This guidance, released on May 11th, reiterates that all FDA-approved contraceptive methods must be covered by insurance plans. While PHAN applauds the Obama administration for clarifying the requirements, we encourage women to understand their rights and report any violations.
If you or a loved one has struggled with your insurance company to obtain your preferred method of birth control, or if you feel you are paying unnecessary out-of-pocket costs toward your prescription, please call Pennsylvania Health Access Network at (877) 570-3642 or visit www.coverher.org.
Emily A. Eckert is a Community Health Organizer and Certified Navigator at the Pennsylvania Health Access Network.