Keep­ing the pill af­ford­able

Los Angeles Times - - SUNDAY OPIN­ION -

In the 50 years since Gris­wold vs. Con­necti­cut — in which the U.S. Supreme Court struck down a Con­necti­cut law ban­ning con­tra­cep­tion for mar­ried cou­ples— the right to birth con­trol for all has be­come a cor­ner­stone of women’s healthcare and re­pro­duc­tive free­dom. But mak­ing it af­ford­able to all women has not been easy. It wasn’t un­til 2000 that em­ploy­ers who of­fered pre­scrip­tion drug cov­er­age were com­pelled to cover pre­scrip­tion birth con­trol as well. More re­cently, de­spite protests from Repub­li­cans and re­li­gious groups, the con­tra­cep­tive man­date in the Af­ford­able Care Act was en­acted, re­quir­ing all in­sur­ers to cover birth con­trol with no co­pay.

Nowthere are new ef­forts to make it eas­ier for some oral con­tra­cep­tives to be to be sold over the counter, like as­pirin, rather than by pre­scrip­tion only. Wouldn’t that guar­an­tee the most ac­ces­si­bil­ity? The­o­ret­i­cally, yes, but not if women are stuck buy­ing it with­out ben­e­fit of in­sur­ance. Con­sider Se­nate Bill 1438, in­tro­duced by U.S. Sens. Kelly Ay­otte (R-N.H.) and Cory Gardner (RColo.). That bill would in­cen­tivize drug com­pa­nies to ap­ply to the Food and Drug Ad­min­is­tra­tion for per­mis­sion to make their pre­scrip­tion con­tra­cep­tives avail­able over the counter by giv­ing the drugs pri­or­ity re­view and waiv­ing the fee to ap­ply. The bill would also re­peal the Af­ford­able Care Act’s ban on us­ing a flex­i­ble spend­ing ac­count for over the counter med­i­ca­tions.

All that sounds great. There’s just one big prob­lem. Only pre­scrip­tion drugs must be cov­ered by in­sur­ers un­der the Af­ford­able Care Act. There is no such re­quire­ment for over-the-counter med­i­ca­tions. Many women— if not all— would find them­selves pay­ing out of pocket for con­tra­cep­tion after not hav­ing to pay any­thing for it un­der the Af­ford­able Care Act.

Op­po­nents of the bill, in­clud­ing the Planned Par­ent­hood Ac­tion Fund and the Amer­i­can Congress of Ob­ste­tri­cians and Gyne­col­o­gists, have pointed out that birth con­trol isn’t re­ally ac­ces­si­ble un­less it’s af­ford­able. And with­out in­sur­ance, oral con­tra­cep­tives can cost as much as $600 a year. Fur­ther­more, the bill would bar any­one younger than 18 from pur­chas­ing the pills over the counter (al­though they could still get them with a doc­tor’s pre­scrip­tion).

The bet­ter al­ter­na­tive is Se­nate Bill 1532, just in­tro­duced by Sen. Patty Mur­ray (DWash.). It calls for the con­tin­u­a­tion of com­plete in­sur­ance cov­er­age of any oral con­tra­cep­tive after it goes from pre­scrip­tion to over the counter. It would not set an age re­quire­ment for pur­chase.

The Amer­i­can Col­lege of Ob­ste­tri­cians and Gyne­col­o­gists said in 2012 that oral con­tra­cep­tives are safe enough to be avail­able over the counter. Not only are they likely to de­crease un­in­tended preg­nancy rates, but they carry lower med­i­cal risks than preg­nancy and have fewer side ef­fects than many medicines al­ready avail­able over the counter at gro­cery stores. The group does not be­lieve the drugs should be kept from users younger than 18.

The Se­nate would be smart to pass the Mur­ray bill. If the FDA ap­proves mak­ing oral con­tra­cep­tives avail­able over the counter, Congress should con­tinue to re­quire in­sur­ers to cover its cost.

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