Student health centers look for price relief

Tick off the contraceptive options now available at your clinic. If you are a provider at a university health center, chances are your list may be shorter than it was in 2007.

Why? When institutions of higher education no longer qualified for special reduced pricing for contraceptive supplies in 2007 as a result of changes in the federal Deficit Reduction Act (DRA), pharmaceutical companies began charging college and university health centers significantly higher rates. While some health centers were able to stockpile or stretch their supplies, many centers had to immediately revise their formularies to carry lower-priced options, says Mary Hoban, PhD, CHES, staff liaison for the American College Health Association (ACHA), which is monitoring the situation.

The pricing impact has hit centers in waves, notes Hoban. For institutions that had enough cash on hand in 2007 to stockpile existing contraceptive choices, providers initially were able to continue to offer contraceptive options at pre-legislation change prices. With stockpiled resources dwindling, centers have had to reformulate their formularies to offer lower-priced drugs, says Hoban. In the cases in which no generic equivalent is available, such as NuvaRing (Organon USA; Roseland, NJ) and Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ), use of such options has been dropped or severely curtailed. "I'm hearing from our providers that they are frustrated," states Hoban. "They feel like they are having to prescribe based on the cost, rather than what they think is the best product or medication for their patient."

Some centers are reporting upticks in requests for emergency contraception and pregnancy tests, while other facilities are reporting that women's health visits are down, Hoban states. Because some students may be foregoing hormonal contraception due to price increases, they may not be coming in for clinic visits, she surmises. A decline in patient visits results in less revenue, further impacting centers, says Hoban.

Student health centers aren't the only reproductive health clinics impacted by the legislative change. About one-quarter of Planned Parenthood Federation of America centers were extended the same type of nominal pricing. Under the old legislation, these clinics, as well as university health centers, were considered "safety net providers" and were extended the same type of nominal prices as those in the 340B Drug Pricing Program, run by the federal Office of Pharmacy Affairs. With the legislation change, however, only "340B entities, intermediate care facilities for the mentally retarded, state-owned or operated nursing facilities, or any other facility or entity deemed a safety net provider by the Secretary of the Department of Health and Human Services" are qualified for such pricing.1

Is relief in sight? Legislation in the form of companion bills, HR 4054 and S2347, both termed the Prevention through Affordable Access Act, have been introduced, says Hoban. The bills will make a technical correction to the DRA and restore safety net and university clinics' ability to access low-cost contraceptives. The bipartisan legislation will not cost the federal government or state Medicaid agencies any monies; it will merely allow drug manufacturers to offer deeply discounted prices to safety net health care providers, Hoban explains. ACHA is working behind the scenes with key legislators to help propel the legislation forward, she states.

While the legislation is in motion, one school has stepped in to help keep contraceptives affordable for its students. In response to student concerns, the president and provost of Princeton University have agreed to provide funds to subsidize the cost of oral contraceptives available at Princeton University Health Services (UHS), pending continued federal discussions about funding, says Cass Cliatt, university spokeswoman. "The university's subsidy is designed to restore the price of oral contraceptives currently offered at University Health Services for students to levels preceding the federal changes, and this began Dec. 1, 2007," she states. "On that date, birth control pills sold at UHS returned to being sold for $6 per pack, reduced from the $15 resulting from the federal changes."

The UHS ran out of brand-name oral contraceptives in March 2007 and began selling the generic brand Cryselle for $15 per pack that month and the generic brand Aviane for the same price in May 2007, says Cliatt. Cryselle (0.3 mg norgestrel and 0.03 mg ethinyl estradiol tablets) and Aviane (0.10 mg levonorgestrel and 0.02 mg ethinyl estradiol tablets) are manufactured by Barr Pharmaceuticals, Pomona, NY, and are the generic equivalents of Lo/Ovral and Alesse, both manufactured by Wyeth Pharmaceuticals, Madison, NJ.

To get out the news about the subsidy, UHS officials notified current student clients directly, as well as peer health educators on campus, the Women's Center, the Student Health Advisory Board, the Graduate School Government, and other student networks, says Cliatt. An announcement also was posted on the University Health Services web site, she states.

How much money is included in the subsidy? According to Cliatt, early estimates for the cost to the university come in at about $69,000. While university officials expect the cost to be significantly below this figure, they do not as of yet have a forecast to provide a final figure, she states. The subsidy is being supported through discretionary funding.

How has the university subsidy allowed the center to better serve students when it comes to contraception? "There were a number of students who voiced concern about losing access to affordable oral contraception as a result of the federal changes, and the university provided the subsidy to address these concerns," states Cliatt. "To be clear, the goal is not to introduce new products and subsidize oral contraceptives globally; rather, we are returning to the former status quo for the oral contraceptives the university already provides."

Clinicians at the health services continue to provide prescriptions for students who prefer to use brand-name contraceptives, says Cliatt. Students may use their prescription plans to help pay for them, she states.

Reference

  1. 109th Congress. Federal Reduction Act of 2005, Pub. L No. 109-171, 2006.