Complex Insurance Schemes Create Barriers to Contraceptives Despite Obamacare Coverage Requirements

Vox (Sept. 6, 2016): Obamacare was supposed to make all birth control free. As a doctor, I see that is not happening, by Tracey Wilkinson:

This article by Tracey Wilkinson examines the gap between the promise of free birth control under Obamacare and the realities for women seeking insurance coverage for contraceptives. She writes:

Too often, I have patients return or call my office telling me that their insurance didn’t cover the birth control I prescribed, that there was a copay they could not afford or some roadblock has appeared that effectively denied them the method of contraception we had discussed.

Although Obamacare requires that insurance companies cover 18 different types of FDA approved contraception, it does not mean that insurers must cover all drug within those categories.  For instance the 18 types of contraception include three types of oral contraceptive pills, but there are over 100 contraceptive pills on the market. Insurers need only cover one of each type of pill and can change the drug they cover without notice.  Even if the doctor prescribes the medication covered by a woman's insurance, her pharmacy might not stock it. 

Also insurance companies can require that women try a cheaper option before it covers a more expensive form of contraceptive or require that the doctors complete a waiver or exemption process to justify the prescription of certain contraceptives.

The Kaiser Foundation recently issued a report documenting these types of administrative barriers in 5 states.  The report found a wide variety of contraceptive coverages.  Perhaps more concerning, the researchers noted that it was difficult to compile the information for the report because coverage information "was not always easy to find, readily available, or even known by the insurance company employees. This highlights again how challenging this is for a consumer or clinician."

Dr. Wilkson laments the de facto restrictions on contraceptive access.  In addition to the burdens on doctors and patients, she notes that there is no benefit to withholding contraception. She states:

What is most frustrating about the current state of contraceptive coverage is that it’s hard to determine who, if anyone, benefits from this restricted access. Unplanned pregnancies are very expensive not only to society but also to insurance companies. The cost of paying for contraception for a year (or even 10 years) is significantly cheaper than paying for prenatal care and subsequent labor and delivery. The estimated costs of unplanned teenage pregnancies in the United States each year is $9.4 billion.

In addition to the financial costs of restricting access to contraception, she notes that "[e]vidence exists showing that removing barriers to contraceptive use is effective and leads to a sharp decline in unplanned pregnancy, birth, and abortion rates."