Paying Too High a Price? A Diagnosis for Over-the-Counter Contraception

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

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
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.

Together, we can work to achieve
this. As advocates we must always recognize the cost and insurance pieces
of any reproductive health care service and work to ensure that all
women have access; cost must never be a barrier to accessing these services.

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  • invalid-0

    I agree with the need to make oral contraceptives more accessible, but we shouldn’t overlook the fact that a doctor’s visit provides opportunities for improving overall health. In particular, an annual pap smear can be performed when a woman goes to her doctor for an OC prescription.
    My own gynecologist insists on doing it this way. I’m a doctor myself, and I don’t mind.

    • invalid-0

      I really think that there are some risks with clotting associated with even BC pills that are prescribed to you by a doctor. I had migraines off and on for weeks until I sorted it out and found another method of MC that works for me (NuvaRing). Luckily my gynecologist was able to get me in the next day after I called her with my concerns.

      I am for having BC be far more accessible though. It’s a fine line indeed…

  • invalid-0

    Thank you for this thoughtful piece, Myra. Wisconsin’s Medicaid Program and our Family Planning Waiver covers EC as a prescription drug, but just because something is available over the counter doesn’t mean it can’t be prescribed. Of course, for minors, it is not available without a prescription.

    As family planning clinics, we often overlook opportunities to market our own unique and vital services. We have established a state-wide EC hotline (866-EC FIRST)where women can enroll in our MA FP program and get a prescription for EC-in-advance as well as for ‘needed now.’ We can fax a prescription to a pharmacy, deliver overnight, we have lockboxes at some clinics, and we have “EZEC agreements” with women’s shelters and other agencies for rapid and convenient (and ‘free’ if you’re MA enrolled) EC.

    WI will have a conference on “EC – Not Just an Afterthought” May 13th and 14th in the WI Dells. ( for more info) This is an invitation for all of you to come and we can share your great ideas and our pretty good ones on how to make EC more accessible.


  • invalid-0

    Since EC is nothing but a high dose of BC pills, it is an outrageous Big Pharm rip off that they should cost $50. It’s yet another profit payoff to the drug companies. In terms of relative risk to life and health, we should be putting BC pills in gumball machines and requiring prescriptions for cigarettes! And if BC pills had been originally marketed as cancer prevention (which they are) – nobody would have any problem with their OTC use.