Representative Nita Lowey (D-NY) has reintroduced the "Equity in Prescription Insurance and Contraceptive Coverage Act" (H.R. 2412) in the House of Representatives. The bill would require employer-based health plans to cover prescription contraception at the same level they cover other prescription drugs.

If passed, Lowey's bill could rectify a longstanding unfairness in prescription coverage by health insurance plans while helping to lower our nation's unacceptably high rate of unplanned and unwanted pregnancies.

The Facts

Full contraceptive coverage is inexpensive. Lack of coverage greatly contributes to health care costs for women of reproductive age: nationally, women pay 68% more in out-of-pocket health care costs than men. Research shows that full contraceptive coverage would cost the employer, at most, $24.40 per employee per year. While birth control pills cost an average of $300-$359 per year, the average cost of having a healthy baby is $10,000. The fact is that not covering contraception in employee health plans costs employers 15-17% more in direct and indirect costs than providing coverage.

Full contraceptive coverage is popular. A national poll indicated that 78% of privately insured adults support contraceptive coverage, even if it would increase their costs by five dollars a month.

Full contraceptive coverage makes sense. 95% of American women use contraception at some point during their reproductive years. More than 50% of women who use contraception use prescription methods. However, a Kaiser Foundation Survey showed that in 2002 only 78% of insured employees had coverage of oral contraceptives.

The truth

Contraceptive equity is inexpensive, popular and it just makes sense.

Source Cover My Pills: Fair Access to Contraception, June 2007

Insurance Coverage for Contraceptives: FAQs

Why is contraceptive coverage important to Population Connection? Population Connection believes that the best way to slow population growth is to give women access to voluntary family planning so that they can control the number and spacing of their children. While most insurance companies claim that prescription contraceptives are not "medically necessary," most women view contraception as a fundamental component of basic health care. When nearly 50% of all pregnancies in the United States are unintended and women are paying 68% more than men in out-of-pocket health care costs, it is imperative that family planning is accessible and affordable.

What is a contraceptive coverage bill? A contraceptive coverage bill says that if an insurance plan covers prescriptions, it must also cover reversible prescription contraceptives, such as the pill, diaphragm, Norplant, IUD, and Depo-Provera. It would ensure that these prescriptions are treated like any other prescription.

Don't most insurance companies already cover contraceptives? No. Most health plans that cover prescriptions do not cover prescriptions for reversible contraceptives. In fact, only 15% of all insurance plans cover all five FDA-approved prescription contraceptives. Only about half of all insurance companies cover any method at all.

Will the coverage of contraceptives make my health insurance more expensive? Only slightly, if at all. It is estimated that the coverage of prescription contraceptives would increase the cost of health insurance by about $21.40 per employee per year. This does not figure in the significant cost savings accrued by preventing unintended pregnancies; for each woman supplied with prescription contraceptive coverage over a five-year period, an insurance company saves a minimum of $10,000. This is because the costs associated with unintended pregnancy are much higher in comparison to the cost of contraceptives.

Is this a federal bill or a state bill? Both.

How does the federal bill differ from the state bills? The federal bill will apply to all states and all insurance companies. It could also take a long time to pass.

How can I find out if my state has a contraceptive coverage bill introduced? 26 states have contraception equity rules or laws regulating insurance company plans to include prescription contraception. Many of these states have "conscience clauses" (indicated below with a *) which permit religiously affiliated companies to deny coverage even if their employees are not religiously oriented. To find out if your state has introduced a contraceptive coverage bill, you may either call your representative's office, connect to your state legislature's website from Population Connection's home page (http://www.populationconnection.org), or contact Population Connection's Government Relations Department at 1-800-POP-1956.

Talking Points

• The United States is the third most populous country in the world and is growing by nearly 3 million people every year. Only one-third of this growth is a result of immigration; the remainder is a result of the U.S. birthrate. Nearly 50 percent of all pregnancies in the United States are unintended (either unwanted or mistimed). 40 percent of all births every year are the result of unintended pregnancies and 10 percent of births are unwanted.

• About 85 percent of health insurance plans in the United States provide coverage for abortions and sterilizations, but only 15 percent of these plans cover all five FDA-approved reversible methods of contraception (the pill, Norplant, IUDs, diaphragms, and Depo-Provera). Only about half cover any of these methods.

• Contraception is the only FDA-approved prescription benefit that is regularly excluded by insurers, despite the fact that contraceptives are one of the most widely used prescription drugs by many women. For many women in their reproductive years, preventing or delaying pregnancy is among their chief healthcare concerns.

• Women spend 68 percent more in out-of-pocket costs for health care than men. Reproductive health care services account for much of this discrepancy. Since all of the prescription methods of contraception are used by women, women are forced to use their disposable income to pay for family planning services.

• According to a study conducted by the Women's Research and Education Institute, 67% of women of reproductive age rely on private, employment-related insurance coverage, obtained through either their own employer or a family member's employer.

• Contraceptive coverage is extremely cost-effective. Researchers have found that the cost to an insurance company over a five-year period for not providing contraceptive coverage comes to $14,663. Over that same time period, the cost to insurers to cover oral contraceptives comes to $1,784. Providing coverage for oral contraceptives would save insurers close to $13,000. The researchers have also found that other contraceptive methods also offer substantial savings to insurers.

• A 1998 report by the Alan Guttmacher Institute suggests that the average total cost (including administrative costs) of adding coverage for the full range of prescription contraceptives to health plans that do not currently cover them would increase total health care costs for private-sector employees and their dependents by $21.40 per employee per year. (This represents the average cost of adding coverage to a plan that now does not cover any contraceptive methods; the cost would be less for those plans that cover at least some of these methods. This estimate, moreover, does not take into account potential cost savings associated with contraceptive coverage.)

Sources Alan Guttmacher Institute, Planned Parenthood, NARAL Pro-Choice America, and NFPRHA (National Family Planning & Reproductive Health Association), June 2007