By: David Ostrowsky

Since the US Supreme Court decided to undo nationwide abortion rights in summer 2022, women’s reproductive rights has arguably been the most pressing topic in healthcare. Naturally, as we enter the final stretch of election season – as well as the Biden administration – the all-important, polarizing matter has resurfaced.

Earlier this month, the departments of Health and Human Services, Labor and Treasury proposed to broaden a federal mandate (under the Affordable Care Act) obligating private health insurers to cover condoms, birth control pills, and “morning after” pills for women on private health insurance plans – even without a prescription. Currently, health insurers are mandated to cover only the cost of prescribed contraception; should the new rule become law next year, over 50 million more American women on private health insurance plans would be able to go to their local drugstores and pharmacies and purchase these items, irrespective of whether or not they were prescribed. Accordingly, private health plans would also be required to disclose to women that those contraceptives are covered without cost-sharing.

Taking a deeper dive into the proposed rule, it’s apparent that there’s more than just the matter of whether or not a pill is prescribed. Under the Biden administration’s plan, insurers would have to cover all FDA-approved drugs and drug-led combination products, unless the plans also cover a therapeutic equivalent. Therapeutic equivalents, per the FDA, are drugs that have an identical amount of the same active ingredient. At this hour, insurers only need to cover one drug per category of contraception — which could be birth control pills, implants or IUDs — causing some women to have difficulty accessing the precise combination of drugs in the type of prescription contraceptive they so desire.  

Practically speaking, the Biden administration’s proposal could have life-changing consequences for large swaths of the female population in this country. The emergency contraceptives that women on private insurance plans would be able to access without cost – and prescription – most notably include levonorgestrel, more commonly known by the brand name “Plan B,” which is a pill that must be taken immediately after intercourse to prevent pregnancy. As it currently stands, when women don’t have a doctor’s prescription, they may pay as much as $50 for a pack of the pills. Thus, women who may feel inclined to delay purchasing the medication until they get a doctor’s prescription could be compromising the efficacy of the pill – perhaps without even being aware. Moreover, if this new rule is in fact implemented, insurers would have to assume the full cost of Opill, a new OTC birth control pill that the FDA approved last year. A one-month supply of Opill costs $20, perhaps not an extravagant price but nonetheless one that may be prohibitively expensive for some.

Vice President Kamala Harris, who has affixed her presidential campaign to a pledge to embolden women’s healthcare rights, trumpeted her administration’s proposal, declaring in an official statement:

“Every woman in every state must have reproductive freedom and access to the health care they need. That is why I have fought to lower health care costs and protect the ability of every woman to make her own decisions about her own body."

 
“Today, our Administration is proposing the largest expansion of contraception coverage in more than a decade. This new proposed rule will build on our Administration’s work to protect reproductive freedom by providing millions of women with more options for the affordable contraception they need and deserve.”

Since the passage of the Affordable Care Act, women have saved billions of dollars that they would otherwise have spent on contraception. But now, for the first time in the history of the United States there is strong potential for universal coverage for no-cost, over-the-counter, no-prescription-necessary contraception, which would save even more billions.