Birth control coverage required in U.S. health plan

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.


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