Keeping the pill affordable

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.