Birth control coverage required in U.S. health plan

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Health insurers led by WellPoint Inc. would be required to cover birth control pills and devices at no cost to patients under the recommendation of a top U.S. scientific advisory board.

An Institute of Medicine panel said Tuesday the government should deem birth control a preventive health service for women of reproductive age. Under the 2010 health-care overhaul, insurers have to cover certain preventive services recommended by the government without requiring co-payments or other cost-sharing by patients.

The panel in a report urged the government to require coverage of "the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures and patient education and counseling” for women who can reproduce.

Insurers have never been told to cover contraceptives such as Warner Chilcott Plc’s Loestrin 24 Fe and Merck & Co. Inc.’s NuvaRing. The products are often too expensive even when they are covered, said Judy Waxman, vice president for health and reproductive services at the National Women’s Law Center in Washington. Alternatives to the pill such as intrauterine devices, or IUDs, costing about $600, often aren’t covered at all, she said.

The recommendation “is an important public health measure that will produce healthier babies and healthier moms,” Waxman said.

Loestrin 24 Fe is the top-selling birth control pill in the U.S. with $533 million in 2010 sales, according to data from IMS Health, a Norwalk, Conn., health-consulting firm. NuvaRing is the top-selling birth control device, with sales of $412 million. The top-selling IUD, Bayer AG’s Mirena, had $348 million in sales.

Birth control would have to be covered for free by insurers offering new plans in 2013 under the recommendation before Health and Human Services Secretary Kathleen Sebelius, Waxman said. Plans that are considered “grandfathered” under the health-care law wouldn’t have to comply.

Sebelius said in a statement that her department would review the recommendation and “very soon” issue required preventive services.

“This report is historic,” she said. “Before today, guidelines regarding women’s health and preventive care did not exist.”

Health plans already encourage customers to seek preventive care recommended by independent authorities, and requiring insurers to cover additional services such as birth control may raise costs, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade group in Washington, D.C.

“Broadening the scope of mandated preventive services that go beyond or conflict with the current evidence-based guidelines will increase the cost of coverage for individuals, families, and employers,” he said in an e-mail.

Planned Parenthood said insurance co-payments for birth control typically cost $15 to $50 a month.

The recommendation would mean opponents to the use of birth control would still have to buy insurance that covers it, said Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council, a Christian nonprofit in Washington.

Her group also doesn’t want emergency contraceptives that she said can be used to abort a pregnancy, such as over-the- counter emergency contraceptive Plan B, included among birth control products that are required to be covered.

“The real issue is less about birth control as such; it’s rather about specific contraceptives that can function as” substances that induce abortion, she said.

Linda Rosenstock, the dean of the University of California Los Angeles School of Public Health and the chairwoman of the Institute of Medicine panel, said the group wasn’t directed to consider “personal beliefs” in its work.

“Our charge was to look at the evidence for the effect of services,” she said by phone. “There’s very strong evidence that unintended pregnancy carries adverse consequences for the mother as well as the child.”

The Institute of Medicine panel also recommended that the government require coverage of testing for HIV and human papillomavirus, or HPV, another sexually transmitted disease; screening and counseling for domestic violence; breast-feeding counseling and equipment; and gestational diabetes, common to pregnant women.

One of the 16 members on the panel dissented from the report in an uncommon action, said Christine Stencel, a spokeswoman for the National Academies.

Anthony Lo Sasso, a professor at the University of Illinois at Chicago’s School of Public Health, said the panel shouldn’t have made any recommendations because its work was rushed and there was little scientific evidence the services lead to “lower rates of disability or disease and increased rates of well-being” among women.

“The recommendations were made without high-quality, systematic evidence of the preventive nature of the services considered,” he wrote. In a response, the other 15 panel members wrote that “no other member shares the opinion that report recommendations were not soundly evidence-based.”

Sebelius, too, said the report was based on “science and existing literature.”

Rosenstock said that the rest of the panel felt there was “adequate time” to deliberate and that Lo Sasso wanted the recommendations to weigh the cost of preventive services.

“We were asked not to consider cost as part of our considerations,” Rosenstock said.



  • Ben
    Ben - I appreciate your views. You would have to agree that implantation prevention is only a backstop if the other 2 methods fail, correct? Therefore it is not the primary means by which HBC works.

    I cannot provide any evidence that HBC causes long-term side effects such as impaired fertility, but I also cannot find any evidence of the long-term side effects of using HBC. The admittedly antecdotal experiences of my friends and family suggest that after years and years of using HBC, female's reproductive system may need to be shocked into remembering how to function properly with (drumroll....) more pharmaceuticals and countless visits to OBGyns and specialists.

    My only angle here is that people need to think more critically before popping every pill that their doctor suggests. Perhaps the benefit outweighs the costs when it comes to HBC. Not sure, but buyer beware.
  • birth control

    The link you posted says that it works by both mechanisms:


    It states in part:

    "Pregnancy is prevented by a combination of factors. The hormonal contraceptive usually stops the body from releasing an egg from the ovary. Hormonal contraceptives also change the cervical mucus to make it difficult for the sperm to find an egg. Hormonal contraceptives can also prevent pregnancy by making the lining of the womb inhospitable for implantation."

    which implies that although it typically prevents the release of an egg or fertilization, it also works by preventing implantation in at least some cases.

    Hormonal birth control is controversial in some circles that worry about every fertilized egg in all situations (I am not in this group). For example,

    I couldn't find any evidence that hormonal birth control reduces the chance of later conception beyond a few months after stopping the treatment. Can you provide any non-anecdotal evidence? My peers (late 20s early 30s) who have gone off of HBC seem to be having plenty of kids without issue but that doesn't prove anything.

    HBC is widely used and side effects have been studied extensively. For example,
    it seems to increase the risk of a blood clot and there is some disagreement about if it increasing the risk of breast cancer.

  • know more than you
    jane, jane, jane....please get educated. Most birth control DOES work by blocking ovulation. If it worked by stopping a fertilized egg from implanting, I am guessing it would be a wee bit more controversial, don't you?


    As you say, there has been a lot of research on birth control, but it has all been on its effectiveness, not its side effects. If you take birth control, you are risking your bodies ability to know what to do on its own later. Think about it, your body gets dependent on the artificial hormone treatment just like your body gets dependent on any drug.

    There is too much money in birth control and fertility treatments for anyone to look into this.
  • Little knowledge
    Shows what little knowledge you have of birth control - it doesn't stop ovulation, it stops the egg from being implated. People can have all types of trouble having a baby wehn they didn't even use birth control. Don't blame something that has had hundreds and hundreds of hours of research when you don't even know how it works.
  • long term impact?
    It is no coincidence that so many people that have taken birth control for years / decades have difficulty with getting pregnant when they are ready. You cannot have a drug block ovulation for 10 years and then just expect your body to work perfectly at the flip of a switch. Much research needs to be done.
    • About Time!
      For years insurers have covered Viagra for men. It's about time that they also covered birth control it is a small cost to pay for an unwanted pregnancy. We see it all to often people who don't or shouldn't have children get pregnant. Unfortunate but true many of these children become abused and or dead. Living with the thought that they were unwanted or unloved. Not that this always is the case but lets at least get with the times and realize this does happen and do what we can to prevent it!
    • Birth control coverage
      I'm to old now it should have been in place
      a long time ago!!

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    1. You are correct that Obamacare requires health insurance policies to include richer benefits and protects patients who get sick. That's what I was getting at when I wrote above, "That’s because Obamacare required insurers to take all customers, regardless of their health status, and also established a floor on how skimpy the benefits paid for by health plans could be." I think it's vital to know exactly how much the essential health benefits are costing over previous policies. Unless we know the cost of the law, we can't do a cost-benefit analysis. Taxes were raised in order to offset a 31% rise in health insurance premiums, an increase that paid for richer benefits. Are those richer benefits worth that much or not? That's the question we need to answer. This study at least gets us started on doing so.

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