Cover Story: Restricted Access

How legislation, moral views and pricing are changing the availability of birth control locally

Since the Supreme Court has yet to reverse Roe v. Wade, ladies, it's still your body and it's still your choice. And whether or not you choose to pop the pill, wear the patch or regret it the morning after, planning if and when you start a family is a legal right — even though flawed legislation, health insurance plans and some pharmacists seem to be standing in your way.

Affordable birth control pricing is currently the No. 1 public policy issue for the Planned Parenthood Federation of America. Because of the Congressional Deficit Reduction Act of 2005, which went into effect in January of 2007, a pack of birth control pills that used to cost $4 now costs $40.

Through a tightening in wording, the act inadvertently prevents pharmaceutical companies from providing low-cost prescription contraceptives to university health centers and hundreds of safety net health providers, like Planned Parenthood, nationwide — a service they used to offer freely in accordance with the 1990 Medicaid Anti-Discriminatory Drug Price and Patient Benefit Restoration Act.

"More than 3 million college students and hundreds of thousands of low-income women have lost access to affordable birth control because of the language that the Senate Finance Committee drafted," says Laurie Housemeyer, Vice President of External Affairs for Planned Parenthood in Southwest Ohio.

According to Planned Parenthood, the Deficit Act of 2005 was drafted because Congress was concerned that manufacturers were selling these nominally priced drugs for purposes beyond the intent of the 1990 Act. In order to control the problem, they closed the loopholes and consequently lost the cheap contraceptives.

Legislators now need to write certain language back in to allow the providers access to the nominal pricing.

"It's a no-cost, technical fix," Housemeyer says.

Just two years ago, the University of Cincinnati's student health insurance plan, which every student is required to enroll in if they aren't currently covered, didn't even address contraceptives. There wasn't any reason to increase every student's insurance premiums, specifically the males, when birth control was so readily available.

"Birth control was so cheap there was no need to cover it," says Melca Wallace, R.Ph, head pharmacist at UC.

With the increased cost from the Deficit Reduction Act, the students demanded coverage.

"With more expensive medications (students) are often put in an awkward position between buying a book, paying for their education or getting their birth control," Wallace says. "The only thing that has spared us is that the insurance is bearing the brunt of the increase in cost. There's a brand name contraceptive, and it retails actually for $60. The person pays a $30 co-pay and the insurance pays the other $30. But then the insurance premiums go up."

Ohio's Planned Parenthood chapter was affected in a different way than the university system. Ohio receives Title X funding, part of the Public Health Service Act, to support federal programs on family planning and reproductive health care services, covering basically everything except abortions. This allows Planned Parenthood to offer a sliding fee scale for birth control, which means its charges change based on income.

Currently, any woman can visit a Planned Parenthood clinic and, without even a pelvic exam, walk out with a three-month supply of prescription contraceptives. (If you want the pills refilled, however, you must undergo a gynecological exam.)

In order to relieve some of the pressure other providers are feeling, Planned Parenthood has put the Ohio Prevention First Act in front of legislators. This omnibus-style bill encompasses birth control contraceptive equity, which would require health insurance carriers who cover any other prescription drug to also cover any prescription contraceptives; money for teen pregnancy prevention programs, which would streamline/make medically accurate the sexuality education programs in public schools; access to emergency contraceptives in the emergency room for women who are victims of sexual assault; and pharmacy refusals of any contraceptive, emergency or not.

Although federal law requires insurance coverage of contraceptives for federal employees and their dependents, only 27 states require that insurers who cover prescription drugs cover the full range of FDA-approved contraceptive drugs and devices, according to the Guttmacher Institute, a nonprofit think tank that promotes reproductive health. Ohio isn't one of these 27 states.

Ohio also currently does not offer emergency contraceptive information in the emergency room for victims of sexual assault, nor does it offer the opportunity to take the contraceptive itself.

Emergency contraception (EC), also known by the brand name Plan B, was first approved for over-the-counter use for females over the age of 18 in August 2006. Emergency contraception is not RU-486 or the Morning After Pill, and it won't trigger an abortion.

EC is similar to a birth control pill. If you missed a pill, had unprotected sex or were sexually assaulted, taking EC within 72 hours will prevent a fertilized egg from implanting in your uterus. If the egg has implanted, it won't affect the pregnancy or harm the developing fetus.

Even though EC is an over-the-counter medication and not a prescription, pharmacists are still responsible for handing it out. Because Ohio has no enforcement mechanisms in place, pharmacists have the right to refuse to sell emergency contraception or even to fill a prescription for regular birth control.

The oath of a pharmacists states that they must maintain the "highest principles of moral, ethical and legal conduct and will embrace and advocate change in the profession of pharmacy that improves patient care." Based on this oath, many pharmacists have refused to dole out the EC pill, stating that life begins at conception.

Karen Brauer, member of Pharmacists for Life International, the only pro-life pharmacist organization, sparked a national debate in 1996 when she refused to fill a contraceptive prescription at a Kmart pharmacy in Delhi.

According to Planned Parenthood, regardless of your pharmacist's point of view there should always be someone on staff willing to fill your legal prescription for birth control or to complete your sales transaction for an over-the-counter emergency contraceptive. And if there is no one on staff, a pharmacist is obligated to refer you to another pharmacy.

I conducted my own experiment and attempted to purchase emergency contraceptive from 10 different pharmacies around Cincinnati. Eight out of the 10, including CVS, Walgreens and a family pharmacy, had an emergency contraceptive in stock and were willing to sell it to me. One Kroger said they were out, and the Kmart I visited doesn't stock it at all.

Planned Parenthood says that it's working hard to get the Ohio Prevention First Act passed before the November election. According to the group, both Democratic presidential candidates are pro-choice and will put women's reproductive health on the forefront, but if the pro-life Republican candidate John McCain is elected there's a chance he could make appointments to our Federal Judiciary, including the Supreme Court, and overturn Roe v. Wade.

If that happens, "There is a series of trigger legislation that will be put into motion at the state levels, which would further restrict a woman's access to reproductive health care, which could include access to oral contraception or other methods of contraception," Housemeyer says. "The threat is definitely there and that would be very, very unfortunate."

Those born after 1973, like me, might not understand what it's like to be without a choice.

"There's a whole generation of women and men who don't realize how their reproductive rights are being threatened," Housemeyer says. "And it's not just a women's issue." ©

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