Affordability questions persist around over-the-counter contraceptives

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The FDA’s decision to consider the first birth control pill that can be sold without a prescription could solve some problems with access to contraception. But loopholes in insurance coverage rules could make it unaffordable for some.

Why is this important: Birth control has played a crucial role in reducing unwanted pregnancies, and advocates say it’s even more important to make it as widely and easily available as possible now that abortions are banned in many states.

The big picture: “It expands the availability of contraception. But there is no silver bullet to solve all access and affordability issues,” said Alina Salganicoff, senior vice president and director of health policy for women for the Kaiser Family Foundation.

Driving the news: The FDA has scheduled a joint advisory committee meeting on Monday to review HRA Pharma’s application for what could be the first over-the-counter birth control pill in the United States.

Between the lines: Eliminating the need for a prescription could make it easier for women to get the pills, especially in areas with a shortage of suppliers or for people who can’t miss work for doctor visits. .

  • But that convenience might mean little if patients have to pay out of pocket for their birth control and can’t afford it.
  • “You both have to have a place to get it, and OTC is increasing the places you can get it, and you have to have a way to pay for it,” said Mara Gandal-Powers, director of access at the birth control at the National Women’s Law Center. “These two things have to work together for people to get their birth control.”

The other side: Some anti-abortion groups argue that reproductive decisions should be made with a doctor and question whether drugs should be made available without the involvement of a doctor or pharmacist, according to The New York Times. reported last year.

Where is it : The Affordable Care Act requires insurers to cover contraception without cost sharing. But it has generally been interpreted to apply when patients have a prescription.

  • Federal guidelines published in July reiterated that plans must cover emergency contraception, including over-the-counter, without cost sharing “when the product is prescribed to a person by their treating provider,” and said plans are “encouraged” to do likewise when a patient does not have a prescription.

  • The guidelines also state that health savings accounts, flexible health spending arrangements, and health reimbursement arrangements can reimburse patients for over-the-counter contraception without a prescription.
  • Some states have gone further than the federal government and require plans to cover some or all over-the-counter contraceptives without a prescription, according to the Contraceptive Access Initiative.

By the numbers: An individual pack of birth control pills is between $20 and $50 without insurance. Annual costs can reach up to $600, per National Women’s Health Network.

  • More than two-thirds of women who use a prescription contraceptive method said the medication is always fully covered, according to the Urban Institute.

What we are looking at: Advocates — including CAI — want the administration to issue updated guidelines.

  • “The federal government should take the long overdue step of releasing a new FAQ document – ​​as soon as possible – that explicitly states the obligation of health plans to cover over-the-counter contraceptive products without cost sharing and, importantly, without a prescription. “, the group argues in a white paper.
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