CONTRACEPTION: OB/GYNs Call For Insurance Coverage
Denying coverage for contraception under health insurance plans "places an unfair burden on women, a practice that amounts to gender bias," officials of the American College of Obstetricians and Gynecologists said Friday at their annual clinical meeting in New Orleans. The group called for passage of legislation that would enforce "equitable coverage" for women when private insurers do not voluntarily include contraception in their prescription health benefits package. An ACOG-endorsed bill now pending in Congress (S 766/HR 2174) would require insurers who cover prescription drug benefits and outpatient services to cover all FDA-approved contraceptive drugs and devices as well as outpatient visits related to their use. "There's nothing 'optional' about contraception. It's a medical necessity for women during 30 years of their lifespan," said Dr. Luella Klein, ACOG's director of women's health issues. "To ignore the health benefits of contraception is to say that the alternative of 12 to 15 pregnancies during a woman's lifetime is medically acceptable," she said.
The college notes that almost half (49%) of traditional indemnity health plans do not cover contraception and just 39% of HMOs "routinely cover" five reversible prescription methods of contraception (birth control pill, implants, injectables, IUD and diaphragm). The group also notes that 49% of preferred provider organizations fail to cover any reversible method and only four in ten PPOs cover oral contraceptives. ACOG further contends that even when a plan covers contraception, insurers may limit the number of brands they will cover.
ACOG introduced a list of recommendations at the meeting to challenge insurers on the issue, urging women and their families to "demand coverage of contraception in their employer health plans" and asking employers to "recognize both the cost savings and fairness of adequately insuring their female employees." In addition to calling on insurers to cover prescriptive contraception drugs and devices and outpatient contraceptive services, ACOG said health plans and should "cease other discriminatory limitations on the number of contraceptives approved on a health plan's drug formulary." ACOG also said insurers should stop "ignoring the cost benefits of family planning: insurers' quality assurance plans, as well as industry outcome measurement plans such as HEDIS (Health Plan Employer Data and Information Set), should include reproductive health criteria and data." In the absence of federal action on the issue, ACOG said state lawmakers should continue to pass legislation and regulations and aggressively enforce them. The group also called on policymakers at the federal and state level to "adequately fund" both family planning services in public programs and contraceptive research.
Bills similar to the Equity in Prescription Insurance and Contraceptive Coverage Act have been introduced in 20 states this year, ACOG notes. Maryland's law, effective this October, mandates that insurers cover contraceptive benefits, and Hawaii, Montana, New Mexico, Texas, West Virginia and Virginia already have laws or regulations regarding contraceptive coverage. Klein said, "Women need to know about contraceptive coverage, insurers need to comply, and authorities need to enforce the law" (release, 5/8).