Do you get tired of having to visit your doctor to get a prescription for birth control pills? Would your life be easier if you could just walk into a pharmacy, pick up a packet of pills, pay and walk out - no prescription, no doctor, no hassle?
England may be getting it right - news media has recently covered pilot projects in England offering hormonal birth control pills over-the-counter at pharmacies. And here in the US, many reproductive health advocates are contemplating the same practice. But think about it: what would happen if instead of just paying a co-pay for your pills or obtaining the pills for free through your public health insurance program, you had to pay for the full price of the drug? Before we move to an over-the-counter model, we must ensure that public and private health insurance programs will provide coverage for over-the-counter oral contraceptives so that all women will be able to obtain the product - not just those who can afford to pay a high price.
What We Learned When Emergency Contraception Went Over-the-Counter
Our recent history with Emergency
Contraception (EC) provides an important lesson. After a long
political process, EC was finally made available behind-the-counter
at pharmacies for individuals 18 and over. While this overdue success
expanded access for many women, the high cost of EC remains a critical
barrier for low-income women, including those who are uninsured or depend
on public health insurance coverage. Deborah Reid, Staff Attorney for
the National Health Law Program, explained that, "Particularly in
light of the current economic crisis, the cost of birth control is problematic
to most women and especially for low-income women. This is particularly
true for emergency contraception as it's a time-sensitive medication."
While more than one in ten
women in their reproductive years depend on Medicaid for their health
care, most state Medicaid programs still require women to obtain a prescription
in order for EC to be covered. As a result, many low-income women continue
to face barriers when they go to the pharmacy and discover that the
cost is about $50 on average and their state Medicaid plans won't
provide coverage without a prescription. For women who then must wait
to obtain a prescription, those extra hours or even days could dramatically
decrease the effectiveness of EC. Fifty dollars out of pocket may not
seem like a lot to some, but for anyone living paycheck to paycheck,
it could mean choosing between buying groceries to feed their families
and paying for EC. The reality is that as long as Medicaid will not
provide coverage for EC without a prescription, many low-income women
in this country still do not have real access to over-the-counter EC.
According to a national survey we conducted at the National Institute for Reproductive Health in 2007, eight states have already led the way in providing State Medicaid coverage for over-the-counter EC without a prescription. Around the country, advocates are working to expand coverage in their states and pushing for the expansion of their state public health insurance programs to cover over-the-counter EC without a prescription. The current economic crisis, however, has made this challenge even more difficult.
The lessons we learned regarding the need to balance access, cost and insurance coverage in EC advocacy are important to remember as advocates push for the over-the-counter provision of other oral contraceptives. Though the possibility of over-the-counter access to oral contraceptives is likely at least several years away, advocates are already researching and examining how cost and insurance coverage might work. They are working to ensure that women would be able to obtain oral contraceptives over-the-counter that are still covered by insurance.
Addressing Cost and Access Barriers Across Spectrum of Reproductive Health Care
These cost and insurance barriers
are not solely related to contraception. The issue of state Medicaid
programs not paying for over-the-counter EC recalls the problems that
low-income women have faced for the past thirty years in abortion access.
The Hyde Amendment, first passed in 1976, bars federal Medicaid funds
from being used to pay for abortion except in extreme circumstances,
leaving millions of low-income women without much-needed access to funding
for abortion care. Advocates are working to fight this burdensome
restriction; however, Congress has continued to uphold this restriction
in the annual appropriations bill each year. While grassroots abortion
funds have stepped
in to assist millions of women in paying for abortion services, the
financial barriers to accessing abortion are not on the radar for most
of the country, and many people are still not aware of what the Hyde
Amendment is or the vast problems that it causes.
Ensuring access to reproductive health care, including contraception and abortion, is about more than just the legal ability to obtain these services. As advocates we need to work to ensure that all women have access to needed contraception and abortion services, regardless of their socioeconomic status or the health care program in which they participate. We will not have true reproductive rights until all women have the ability to access quality reproductive health care.
The long-term goal is to establish a universal
health care system that will provide everyone with access to all needed
medical services, including abortion and over-the-counter contraception.
The important steps along the way include providing Medicaid and other
public and private insurance coverage for over-the-counter EC and other forms of birth control without
a prescription, as well as for abortion.
