||The Equity in Prescription Insurance and
Contraceptive Coverage Act|
More than half of all pregnancies in the United States are unintended, and
half of all unintended pregnancies end in abortion. Contraceptives have a proven
track record of enhancing the health of women and children, preventing
unintended pregnancy, and reducing the need for abortion. However, although
contraception is basic health care for women, far too many insurance policies
exclude this vital coverage.
In fact, while most employment-related insurance policies in the United
States cover prescription drugs in general, the vast majority do not include
equitable coverage for prescription contraceptive drugs and devices.
Similarly, while most policies cover outpatient medical services in general,
they often exclude outpatient contraceptive services from that coverage.
This failure is costly, both for insurers who may have to pay for either
maternity care or abortion, as well as the families whose physical and financial
well-being is threatened by unintended pregnancy and lack of access to equitable
coverage for contraceptives.
Senator Olympia Snowe (R-ME) and Representative James Greenwood (R-PA) are
sponsoring The Equity in Prescription Insurance and Contraceptive Coverage Act,
to provide equity in insurance coverage for contraception. The bill simply seeks
to establish parity for contraceptive prescriptions and related medical services
within the context of coverage already guaranteed by each insurance plan.
Under this legislation, plans already covering prescription drugs and devices
would include equal coverage for prescription contraceptive drugs and devices.
Also, plans that include coverage for outpatient medical services would include
outpatient contraceptive services in that coverage. The bill defines
contraceptive services as "consultations, examinations, procedures, and medical
services, provided on an outpatient basis and related to the use of
contraceptive methods (including natural family planning) to prevent an
While plans routinely cover other prescriptions and outpatient
medical services, contraceptive coverage is meager or nonexistent in many
- Half of indemnity plans and Preferred Provider Organizations (PPOs), 20
percent of Point of Service (POS) networks, and seven percent of Health
Maintenance Organizations (HMOs) cover no reversible contraception.
- Even plans that do provide some coverage typically do not cover all
of the five most commonly used reversible contraceptive methods (oral
contraceptives, the IUD, diaphragm, NorplantÒ and Depo ProveraÒ ). Less than
20 percent of traditional indemnity plans and PPOs and less than 40 percent of
POS networks or HMOs routinely allow women to choose among these five
- Coverage of prescription drugs in general usually does not even include
coverage for oral contraceptives, the most commonly used reversible
contraceptive method in the United States. Although 97 percent of typical
indemnity policies cover prescription drugs in general, only 33 percent
include oral contraceptives in that coverage. This leaves two-thirds of
typical indemnity plans covering "prescription drugs" but not the prescription
so many women need access to – oral contraceptives.
Contraception is basic health care for women and a critical contributor to
improved maternal and child health.
- Ready access to contraceptive services increases the likelihood that the
estimated 12 million Americans contracting sexually transmitted infections
each year will be diagnosed and treated.
- As they help women avoid unplanned pregnancies, contraceptive services
help make "planned pregnancies" possible. A study of 45,000 women suggests
that women who used family planning services in the two years before
conception were more likely to receive early and adequate prenatal care.
- The National Commission to Prevent Infant Mortality estimated that 10
percent of infant deaths could be prevented if all pregnancies were planned;
in 1989 alone, 4,000 infant lives could have been saved.
Insurers have relied on women and their families paying out of pocket for
contraceptive services and supplies, forcing financial decisions that may result
in the use of less effective or less medically appropriate contraceptive
- Women of reproductive age currently spend 68 percent more in out-of-pocket
health care costs than men. Much of the gender gap in expenses is due to
reproductive health-related supplies and services.
- The more effective forms of contraception are generally also the most
expensive, often costing hundreds of dollars at the outset of patient use.
Women and their families who must pay out of pocket may well opt for less
expensive and sometimes less effective methods, thus increasing the number of
- Cost analyses for similar bills at the state level have shown that if
health insurance policies were to include coverage for these contraceptive
supplies, annual cost increases would be minimal, only $16.00 per enrollee.
The correlation is clear. Contraception prevents unintended pregnancy and
reduces the need for abortion.
- In any single year, 85 of 100 sexually active women not using a
contraceptive method become pregnant. In contrast, of 100 oral contraceptive
users, only between three and six percent become pregnant in a year.
- Because the likelihood of pregnancy is so great if contraception is not
used, the 10 percent of American women at risk of unintended pregnancy who do
not use contraception account for 53 percent of all unintended pregnancies.
- Reducing unintended pregnancy is key to reducing the number of abortions;
almost half of unintended pregnancies end in abortion.
Prepared with the assistance of The Allen
Guttmacher Institute 4/97.)
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