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by ALYSSA HERSH
According to the Alan Guttmacher Institute, a not-for-profit research organization, a woman who has sexual intercourse for one year without the use of any contraceptive method has an 85% chance of becoming pregnant. However, a recent study confirmed that only 39% of managed care plans and 15% of indemnity plans offer at least some coverage for all five prescription methods of reversible birth control: oral contraception, diaphragms, IUDs, injectables (medroxyprogesterone, Depo-Provera, Pharmacia), and implants (levonorgestrel, Norplant, Wyeth-Ayerst). The study, "Women's Health Care Issues: Contraception as a Covered Benefit," was funded by Pharmacia Corp. and conducted by William M. Mercer Inc., a consulting firm specializing in employee benefits.
With the additional burden of birth control expenses, it is no surprise that the Women's Research & Education Institute, a nonprofit organization supplying information and analyses on women's issues, has found that women pay 68% more in out-of-pocket health-care expenses than men do. The average annual cost of prescription birth control, according to the Mercer report, ranges from $73 for an IUD to $333 for oral contraceptives. This is "a lot of money to a lot of people," said Mary Jane Minkin, M.D., OB/GYN professor at Yale University.
Many managed care organizations continue to assert that only drugs used in the care or treatment of an illness will be included in Rx drug coverage and that "lifestyle"drugs such as contraceptives should be paid for by the consumer. However, the 1998 introduction of Viagra (sildenafil citrate, Pfizer), which has also been termed a "lifestyle" drug, ignited a fury among consumers concerning an apparent double standard in drug coverage. During Viagra's first two months of sales, according to a 1998 Washington Post article by Amy Goldstein, more than half of all prescriptions received some coverage for the medication.
The American College of Obstetricians & Gynecologists claims that this unequal treatment by health insurance is "gender bias"; approved contraceptive devices have been on the market for 40 years, yet they still have not received justice in the insurance world. Gloria Feldt, president of the Planned Parenthood Federation, remarked that "Viagra, in all seriousness, means more sex—and more sex means more need for effective contraception."
A 1998 survey of about 1,000 adults conducted by the Kaiser Family Foundation revealed that 75% of Americans support legislation to include contraception in prescription drug coverage; the same survey found that support for Viagra was much less, at only 49%. Nonetheless, the Mercer report demonstrates that, at most, 39% of private insurance plans offer unrestricted choice of birth control methods.
While the Mercer report found that oral contraceptives are covered by the majority of HMO plans, it also discovered that they are still included in only about one-third of indemnity plans. Most important, the Pill is not suitable for every woman. Minkin contended that "all women should be given options" and that women who cannot afford prescription birth control are forced to choose OTC methods, "which are not nearly as reliable."
Considering the overwhelming public support for contraceptive coverage revealed in the Kaiser survey, one might be led to believe that cost would be the only obstacle. However, Lisa Astor, the primary researcher and author of the Mercer report, maintains that the "average total cost of adding contraceptives to group benefits is approximately $21.40 per employee per year, or less than a 1% increase in total health-care costs." Furthermore, only 20% of this cost, or $4.28, would be paid by the employer, with the remaining $17.12 being covered by the employee (through a $1.42 monthly raise in premiums).
The Mercer report also alleges that denying access to contraceptives, which inevitably results in more pregnancies, can be quite costly to both the insurers and the employers. Minkin asserted that having a child is "a very expensive thing," and terminating a pregnancy is also a "costly event." Surprisingly, the report revealed that 66% of indemnity plans and 70% of HMOs offer abortion coverage, despite a cost that is considerably higher than that for contraceptives.
Considering that 48% of all pregnancies are unplanned, maternity costs to employers and insurers could be drastically reduced with increased access to contraceptives. "If a woman doesn't want to be pregnant, then it's a devastating cost," Minkin concluded. "Looking at it from a strictly dollars-and-cents point of view, [insurers are] not being very smart."
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