Report Shows Sharp Decline In Cost-Sharing For Contraception

Contraceptive pill

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BOSTON (State House News Service) - As the nation grapples with uncertainty around reproductive health, researchers who examined cost-sharing trends for contraception found that it is rare for Massachusetts patients to have to pay for birth control.

Under a 2012 federal law, commercial insurers are mandated to cover at least one form of each type of birth control (such as oral contraceptives and intrauterine devices) without patients having to bear part of the cost.

Following the passage of the federal Patient Protection and Affordable Care Act, the number of contraceptive prescriptions with patient cost-sharing decreased from 98.1 percent in 2012 to 6.5 percent in 2014, according to the new Massachusetts Health Policy Commission report.

The most recent data available shows that this number has dropped even further. Less than 2 percent of patients in 2017 through 2020 had to pay to receive oral birth control medication or follow up care.

Of the 2 percent of oral contraceptive prescriptions that come with cost-sharing, patients consistently pay $40 to $50 for a one-month supply, it says.

HPC researcher Sasha Albert said these are usually costs associated with buying a name-brand medicine where a generic alternative was available.

The analysis also says that saving patients out-of-pocket expenses on contraceptives decreases unintended pregnancies, citing a 2020 study that showed the estimated probability of birth decreased from 8 percent in 2014 to 6.2 percent in 2018 among women in the lowest income group.

Avoiding unintended pregnancies is correlated with a reduced likelihood of living in poverty, higher rates of higher education completion, and increased participation in the workforce, it says. Albert said about half of all pregnancies are unintended.

"There's been a fair amount of research on the contraceptive mandate in the decades since its implementation, finding that it's had many benefits for patients, including markedly lower cost-sharing payments, increased adherence to contraception, increased access to the most effective methods, such as intrauterine devices, or IUDs, that often have high upfront costs, a decrease in the rate of unintended pregnancies and narrowing disparities by income and unintended pregnancy rates," Albert said at an HPC meeting Wednesday morning, where she presented the research findings.

While the report praises the reduction in cost for patients seeking contraception, it adds that for those who do pay parts of the cost of the medicine, the average amount per person has grown over time, rising from $60 in 2017 to $103 in 2020.

It also found that despite a 2017 state law that permits patients to be prescribed a 12-month supply of birth control without sharing the costs, that there has been little uptake of the 12-month supplies. The HPC concluded that the slow pace of uptake may be due to a lack of familiarity with the law among patients, providers and pharmacists.

For the first time, the Food and Drug Administration voted on Wednesday to endorse making birth control pills available without a prescription.

"This is a major step forward in our fight to protect our bodily autonomy and affirm folks' right to make decisions about their body, when to start a family, and their future," Congresswoman Ayanna Pressley said. "The FDA should move to make birth control available over-the-counter without delay. With this far-right Supreme Court and anti-choice legislatures across the country stopping at nothing to attack our reproductive freedom and bodily autonomy, we must use every tool available to protect reproductive health care and affirm it as the fundamental human right that it is."

David Cutler, who leads the HPC's Market and Oversight Transparency Committee, asked Albert if patients would end up paying more for contraceptives if birth control shifted to be over the counter, since most patients do not currently have to pay for their doctor-prescribed medicine.

"It's hard to say how the prospective over the counter birth control pills will be priced, but yes, it is possible that patients will be paying for medication that previously they would have gotten free of charge," Albert said. "But I think, the issue of over the counter birth control pills really gets at, sort of, what the access barrier is for patients. If cost is the main access barrier, then moving pills over the counter doesn't really address that challenge. But if access to the medical system is the barrier, then over the counter birth control may help."

Written By Sam Drysdale/SHNS

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