New methods may rate, but are they covered?

While your family planning patients may be asking about the latest contraceptive methods, they may change their mind about using them if their insurance carriers won’t cover the costs. A just-issued nationwide survey shows that newer reproductive health options such as the contraceptive patch, the contraceptive vaginal ring, and hysteroscopic sterilization are poorly covered by insurance companies when compared to more traditional methods such as the birth control pill.1

While many new contraceptive options are now approved in the United States, the delay in covering such methods is limiting women’s access to them, says Wayne Shields, president and chief executive officer of the Washington, DC-based Association of Reproductive Health Professionals (ARHP). ARHP co-sponsored the survey, along with the New York City-based Planned Parenthood Federation of America and the Washington, DC-based Black Women’s Health Imperative.

"Many newer contraceptive methods have the same efficacy and safety as more traditional methods, but are more convenient and cost-effective for women," says Shields. "As a result, women from all social environments, races, and economic conditions benefit from having access to a broader range of contraceptive options because they help reduce the rates of unintended pregnancies and abortions."

The survey, which included comments from 250 benefits managers representing mid- to large-sized companies throughout the United States, looked specifically at female reproductive health coverage. While contraceptives, in some form or another, were covered by 89% of companies; disparity was found in coverage of various methods. The birth control pill was the most broadly covered method, with 81% of companies offering partial or full coverage, while emergency contraception was the least covered, with just 18% issuing coverage.

Just more than half of the benefits managers said their companies covered new methods such as the contraceptive patch (59%) and the contraceptive vaginal ring (54%). Forty percent of companies cover the cost of intrauterine devices (IUD), 42% cover IUD placement, but removal is only covered by 35%, survey results show.

When it comes to permanent contraception, tubal ligation and vasectomies are covered partially or in full by 54%, yet hysteroscopic sterilization, introduced in 2002, is covered by only 36%, according to the survey results.

Who is making the decisions on reproductive health coverage? According to the survey, the majority of reproductive health coverage decisions are driven by the insurer, not benefits managers, employees, or even recommendations by professional medical societies.1

As popularity of new contraceptive methods grows, look to more insurers to pick up the costs for such options. According to company data, most managed care organizations and third-party prescription benefit plans are covering NuvaRing, the contraceptive vaginal ring manufactured by Organon of West Orange, NJ, says Amanda Mason, company spokeswoman. Organon is continuing to work at the plan and provider level, as well as with employer groups, to further increase coverage of the method, she adds.

Women are seeing better coverage of birth control methods; nearly nine in 10 group insurance plans purchased by employers for their employees now cover a full range of prescription contraceptives, which is three times as many as just a decade ago, according to results of a recent study from the New York City-based Alan Guttmacher Institute (AGI).2 In 2002, 86% of employer-purchased plans typically covered the full range of contraceptive methods, compared with just 28% in 1993; the proportion of plans covering no method at all dropped from 28% to just 2% during the same time period.2

State laws have played a critical role in this improvement; almost half of all U.S. states have laws in place requiring insurers to provide contraceptive coverage to their employees if they cover other prescription drugs. Plans in states with these laws have significantly more extensive coverage than plans that are designed specifically to provide coverage in states without such mandates, study results show.2 (Check the AGI web site, www.guttmacher.org, for an up-to-date overview of state coverage. Click on "State Center," "Prevention & Contraception," and "Insurance Coverage of Contraceptives.")

However, half of all U.S. women live in the 30 states that do not require plans to cover contraceptives, and plans designed for these states offer inferior coverage compared with plans designed for mandate states, according to the study.2 In addition, about half of all Americans with employer-based insurance coverage obtain that coverage from employers who choose to self-insure, rather than purchase a plan from an insurance company. By law, self-insured plans are exempt from state coverage requirements, and the extent of contraceptive coverage in self-insured plans nationally is unknown, according to AGI.

References 

1. Association of Reproductive Health Professionals. Female Reproductive Health Coverage. Accessed at: www.arhp.org/contraceptivecoveragesurvey.

2. Sonfield A, Gold RB, Frost JJ, et al. U.S. insurance coverage of contraceptives and the impact of contraceptive coverage mandates, 2002. Perspect Sex Reprod Health 2004; 36:72-79.