Contraceptive coverage act returns this year

By the time you read this issue of Contraceptive Technology Update, the wheels should be in motion for the reintroduction of a U.S. Congress ional bill of epic importance: the Equity in Pre scrip tion Insurance and Contraceptive Coverage (EPICC) Act of 1999.

The legislation, which failed to pass the 1998 session, again will be sponsored by Sens. Olympia Snowe (R-ME) and Harry Reid (D-NV) and Reps. Jim Greenwood (R-PA) and Nita Lowey (D-NY). The measure calls for equitable coverage of prescription contraceptive drugs, devices, and services under health plans. It would require insurers already providing prescription coverage and outpatient services to include prescription contraceptive drugs and devices approved by the U.S. Food and Drug Administration as part of their health plans.

Although Congress did not pass EPICC legislation last year, it did enact a mandate that federal employee health plans provide insurance coverage for contraceptive drugs and devices if the plans cover prescription drugs.

Many linked the emergence of the two bills as a response to the boom of the impotence drug Viagra, which was quickly included in many health plans. Marilyn Keefe, director of public policy for the National Family Planning and Reproductive Health Association in Washington, DC, disputes that assessment.

"It makes it seem that coverage of Viagra is so outrageous, when I’m not sure that that is really the issue," she observes. "The issue is that women need access to this basic preventive health service [for which] insurers have been providing fairly poor coverage for decades."

Adding contraceptives

Until 1978, many insurance policies did not cover maternity care, notes Rachel Benson Gold, assistant director for policy analysis at the Washington, DC, office of the Alan Guttmacher Institute. This issue was addressed in the Con gressional passage of the Pregnancy Discrimina tion Act.

"You want the debate [now] to be about how family planning is a mainstream basic health care service and that contraceptives are the only class of drugs that seems to be routinely excluded from health plans," Keefe says. "Health plans are very good at covering surgical procedures, like sterilization [which is the most popular method of birth control], are fairly good at covering abortion services, but they are just not totally on track at covering preventive health care services like contraception."

Many insurance plans, including half of traditional fee-for-service and preferred provider organizations, cover no reversible contraceptive methods.1 Even plans that do provide some contraceptive coverage typically do not cover all FDA-approved prescriptive methods. While 97% of traditional fee-for-service plans routinely cover prescription drugs in general, only one-third of them cover oral contraceptives.1

The estimated maximum cost to cover the full range of FDA-approved reversible medical contraceptives in health plans that do not currently cover them is just $21.40 per year.2 Of that figure, $17.12 would be employers’ costs and $4.28 employees’ cost. The added cost to employers amounts to just $1.43 per month per employee, a 0.6% increase. The cost would be less for those plans that already cover some of the methods.

Public support for bill

A 1998 survey shows that nearly three-quarters of privately insured adults support contraceptive coverage, even if it raises costs $1 to $5 each month.3

Several organizations, including the American College of Obstetricians and Gynecologists in Washington, DC, and the American Medical Association in Chicago, supported the 1998 bill and are expected to lobby for the passage of the 1999 bill, as well.

How can family planners become involved? Keefe suggests providers contact their Congress ional representatives and senators and ask them to cosponsor the bill when it is introduced. "Basically, just let [representatives] know that this situation is not fair, it’s not equal, and it’s time to change it in this legislative session," she says. "It is something that American women are not going to continue to put up with, though certainly we have for decades."

(See what states are doing about contraceptive coverage, at right.)

References

1. Alan Guttmacher Institute. Uneven and Unequal: Insurance Coverage and Reproductive Health Services. New York City; 1995.

2. Darroch JE. Cost to Employer Health Plans of Covering Contraceptives. New York City: Alan Guttmacher Institute; 1998.

3. Kaiser Family Foundation. National Survey on Insurance Coverage of Contraceptives. Menlo Park, CA; 1998.