Sep 13, 2022 - Health

Affordability questions linger around over-the-counter birth control

Illustration of a pack of contraceptive pills and abstract shapes.

Illustration: Gabriella Turrisi/Axios

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

Why it matters: Birth control has been crucial in reducing unwanted pregnancies, and advocates say that making it as widely and easily available as possible is even more important now that abortions are banned in many states

The big picture: "It does broaden the availability of contraception. But there is no single magic bullet to solving all problems with access and affordability issues," said Alina Salganicoff, senior vice president and director of women’s health policy for the Kaiser Family Foundation.

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

Between the lines: Eliminating the need for a prescription could make it easier for women to get the pills, especially in areas with a dearth of providers or for people who can't take off work for doctor visits.

  • But that convenience could mean little if patients have to pay out-of-pocket for their birth control and can't afford it.
  • “You have to both have a place to get it, and OTC increases the places you can get it, and you have to have a way to pay for it," said Mara Gandal-Powers, director of birth control access at the National Women’s Law Center. "Those 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 if the drugs should be made available without a physician or a pharmacist’s input, the New York Times reported last year.

Where it stands: The Affordable Care Act requires insurers to cover contraception without cost-sharing. But that has generally been interpreted as applying when patients have a prescription.

  • Federal guidance issued in July reiterated that plans have to cover emergency contraception, including over-the-counter, without cost-sharing "when the product is prescribed for an individual by their attending provider," and said plans are "encouraged" to do the same when a patient doesn't have a prescription.
  • The guidance also says that health savings accounts, health flexible spending arrangements and health reimbursement arrangements can reimburse patients for OTC contraception without a prescription.
  • Some states have gone further than the federal government and require plans to cover some or all OTC 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 the National Women's Health Network.

  • Over two-thirds of women who are on a prescription contraceptive method reported that the medication is always fully covered, according to the Urban Institute.

What we're watching: Advocates — including CAI — want the administration to issue updated guidance.

  • "The federal government should take the long-overdue step of issuing a new FAQ document — as soon as possible — that explicitly states health plans’ obligation to cover OTC contraceptive products without cost-sharing and, crucially, without a prescription," the group argues in a white paper.
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