Davis Orders DMHC to Inform HMOs About Emergency Contraception Coverage Requirement in 1999 State Law
Gov. Gray Davis (D) yesterday ordered the Department of Managed Health Care to inform HMOs in the state that they must provide coverage for emergency contraception regardless of whether members have a prescription from a physician, the Sacramento Bee reports (Rapaport, Sacramento Bee, 3/28). Davis clarified that a state law passed in 1999 requires HMOs to cover the cost of EC when members obtain the pills through a pharmacist within the HMO's network and to cover the cost through a non-network pharmacist when a network pharmacist is not available. A California law that took effect on Jan. 1 allows women in the state to purchase EC, which can prevent pregnancy when taken within 72 hours of sexual intercourse, from a pharmacist without a prescription from a doctor. Only about 700 of the state's 15,000 pharmacists have received certification to dispense EC (AP/Contra Costa Times, 3/28). DMHC Director Daniel Zingale said that HMOs in the state may have had "some confusion" about whether the 1999 law, which mandated contraception coverage, applied to EC, although agency officials said that they "do not know of any cases in which women seeking the drug have been denied by an HMO" (Gledhill, San Francisco Chronicle, 3/28). Walter Zelman, president of the California Association of Health Plans, said that "a great majority of health plans [in the state] are already providing coverage" for EC (Sacramento Bee, 3/28).
The Sacramento Bee reports that women who purchase EC at pharmacies without a prescription from a physician may have to pay more than women who have a prescription or who purchase the pills from a family planning clinic. Women who purchase EC without a prescription often pay between $30 and $70 for the pills, but the treatment costs "far less" when purchased with a prescription, the Bee reports. Most health plans cover at least one of the two FDA-approved brands of EC, and women enrolled in the plans often only have to pay co-payments of $15 to $30 when they purchase the pills with a prescription. Pharmacists have said that the new state law that allows women to purchase EC without a prescription requires pharmacists to first consult with the women, and they often charge a consultation fee, which can increase the cost. Pharmacists must inform women about when to take the pills and must ask "additional questions" to ensure that they "need the drug and know how to use it" (Rapaport, Sacramento Bee, 3/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.