Subject: Comprehensive Contraception Coverage Act
A.1378 (Cahill) / S.3668 (Bonacic)

Position: SUPPORT

Given the federal administration’s intention to rescind the federal contraception coverage requirement under the Affordable Care Act, the NYCLU strongly supports swift passage of A.1378 / S.3668, the Comprehensive Contraception Coverage Act (CCCA). A.1378. NYCLU urges lawmakers to approve S.3668.

The ability to decide whether and when to have a child is essential to women’s health and ability to participate equally in the economic, political, and social life of the nation. Despite this, many women are unable to access contraceptive health care that is right for them.

In 2014, the NYCLU, in partnership with other New York women’s health organizations, conducted survey calls to insurance provider customer service representatives to find out what kinds of contraception these companies cover. This research revealed that most insurance companies were not complying with federal and state law, including inappropriately charging cost-sharing and omitting coverage for various methods of contraception. This lack of coverage puts women at risk of unintended pregnancy.

The CCCA will ensure timely and affordable access to contraception by requiring insurers to cover contraception that is right for the individual patient without a co-payment, allow for access to a year’s supply of contraception, and improve timely and affordable access to emergency contraception. This legislation ensures individuals can better plan their families and their futures, ultimately reducing unintended pregnancies and strengthening the health and well-being of New Yorkers and our communities.

Background

First approved by the Food and Drug Administration (FDA) over 50 years ago, contraception has significantly transformed the cultural landscape in the United States. By providing women[1] with the tools and agency to determine whether and when to have children, contraception has been a catalyst for women’s equal participation in our political and educational institutions as well as the paid workforce. Beyond these fundamental cultural shifts that give way to equal participation, contraception provides essential health benefits that are both related and unrelated to managing fertility. Contraception leads to improved birth outcomes and child health, reductions in morbidity and mortality rates, a decreased risk of developing several reproductive cancers, and contraception is used to treat various menstrual disorders.[2]

While 99% of women use or have used contraception at some point in their lives,[3] lack of comprehensive contraceptive insurance coverage and high co-payments are significant barriers to consistent and effective contraceptive use. Fifty percent of pregnancies in the United States are unintended. The overwhelming majority of unintended pregnancies are due to a lack of contraceptive use or inconsistent/incorrect contraceptive use.[4] Women, on average, spend three decades—more than three-quarters of their reproductive lives—trying to avoid an unintended pregnancy. Ensuring access to contraception is critical to the health and well-being of our families and communities.

In 2002, New York passed the Women’s Health and Wellness Act (WHWA) requiring insurance plans issued in New York that cover prescription drugs to include all FDA approved contraceptive drugs and devices.[5] Passed in 2010, the federal Patient Protection and Affordable Care Act (ACA) and its implementation guidelines aimed to further close the gap by requiring employers to provide insurance plans that cover contraception without out-of-pocket costs for patients.[6]

While these laws represent major steps forward, they have not been enough to close the contraceptive coverage gap.[7] Moreover, the future of the ACA is uncertain and the new Presidential administration and Congress have indicated an intent to dismantle the federal contraceptive coverage requirement.[8] Without these protections in state law, New York is vulnerable to shifts in federal law, guidelines and enforcement. This, in turn, would allow insurers to drop contraceptive coverage without a co-payment and force many individuals to choose less reliable methods of contraception or no contraception at all, increasing the likelihood of unintended pregnancy. New York needs to strengthen its law to close existing loopholes so that all families have access to affordable contraceptive coverage. 

Why New York Needs The Comprehensive Contraception Coverage Act

The CCCA would address gaps in contraceptive coverage for women in New York in three key ways: (1) require insurers to cover any contraception that a health care provider recommends for a woman without a co-payment, (2) ensure that women can access a year’s supply of contraception at one time to reduce the likelihood of an unintended pregnancy, and (3) improve access to affordable and timely emergency contraception.

First, the CCCA would require broad contraceptive coverage and timely access to all federal FDA approved methods of contraception without a co-payment.[9] Thus, the CCCA would provide patients with the information and coverage they need to access the type of contraception that is medically best for them. Contraception is not a one-size-fits-all model. From the birth control pill to the IUD,[10] a variety of contraceptive types and methods exist because not all forms of contraception are effective or appropriate for a woman’s health and her lifestyle. The CCCA ensures that health care providers, not insurance executives, are best able to help patients make health care decisions about the contraceptive method that is right for them.

Second, the CCCA allows individuals to obtain up to a year’s supply of contraception at one time. According to recent recommendations by the Centers for Disease Control and Prevention, providers can enable consistent use of contraception when they “provide or prescribe multiple cycles (ideally a full year’s supply) of oral contraceptives, the patch, or the ring.”[11] Studies demonstrate that dispensing a one-year supply of contraceptives, as opposed to a three-month supply or a one-month supply, is associated with a 30% reduction in the likelihood of an unplanned pregnancy.[12]

Finally, the legislation would allow easier and more affordable access to emergency contraception (EC) when women most need it: in an emergency. While women are now able to obtain EC over-the-counter without a prescription, the cost of doing so ranges between $50-$75. This is cost-prohibitive for many women. Private insurers only cover the cost of EC if an individual has a prescription. EC is most effective when taken within 72 hours of unprotected sex. In order for the cost to be covered by insurance, a woman must find a provider willing to write a prescription, see that provider, and present the prescription to the pharmacy within 72 hours. Women who cannot access a health care provider within 72 hours and cannot afford the cost of purchasing the drug over-the-counter are delayed in accessing care and are at a greater risk of unintended pregnancy.

The CCCA allows pharmacists to fill a “non-patient-specific prescription” for EC, in the same way that flu shots and the shingles vaccine are provided, thus eliminating the tension between the timely provision of care and cost. Consequently, women will no longer need to visit a health care provider to access the care they need to avoid an unintended pregnancy.

Contraception is fundamental to a woman’s health, life, and future. Promoting access to contraception reduces unintended pregnancies and advances public health for women and their families. Lawmakers should not delay in passing S.3668.
 

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[1] The use of the terms “women” and “female” in these comments is meant to capture anyone who is in need of contraceptive care, regardless of their gender identity.
 

[2] Kavanaugh, Megan and Ragnar Anderson. Contraception and Beyond: The Health Benefits of Services Provided at Family Planning Centers. Guttmacher Institute (2013), available at https://www.guttmacher.org/pubs/health-benefits.pdf.
 

[3] Daniels, Kimberley, et al. Contraceptive methods women have ever used: United States, 1982-2010. U.S. Centers for Disease Control & Prevention. National Health Statistics Reports no.62 (2013), available at https://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf (Study finding that 99 percent of sexually active women of reproductive age in 2006–2010 who had ever had sexual intercourse have used at least one contraceptive method at some point in their lifetime.)
 

[4]Supra note 2.
 

[5] N.Y. Ins. Law § 3221 (l)(16) (Statute requiring all federal Food and Drug Administration approved contraceptive services including oral contraceptives, diaphragms, Norplant, Depo Provera, cervical caps, IUDs, and generic equivalents.)
 

[6] Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 199 (2010); 42 U.S.C.A. § 300gg–13(a)(4) (In accordance with the ACA and implementing regulations, the Department of Health and Human Services issued Women's Preventive Services: Required Health Plan Coverage Guidelines, which adopt the independent Institute of Medicine evidence-based recommendations, and require coverage of eight preventive health care services, including all FDA-approved methods of contraception, without cost-sharing. The guidelines and a list of covered preventive health care services for women are available at http://www.hrsa.gov/womensguidelines/.)
 

[7] The ACA requires contraceptive coverage without a co-payment but does not require coverage of the full array of contraceptive types available; this means that individuals may not have the option to choose the type that is right for them. Further, a lack of clarity in the federal law has led to inconsistent implementation and enforcement. In the Spring of 2014, the New York Alliance for Women’s Health (NYAWH), based on research that included blind calls its members made to insurance plans, concluded that some plans that insurers were offering in the NYS Health Exchange were inappropriately charging cost-sharing and omitting coverage of some methods of contraception, putting women at risk of unintended pregnancy.
 

[8] Crockett, Emily. “The Republican Health Plan Wouldn’t Touch Free Birth Control – But that Doesn’t Mean its Future is Safe.” Vox. Mar. 8, 2017, available at http://www.vox.com/identities/2017/3/8/14843636/birth-control-benefit-ah....
 

[9] Further, many insurance companies do not typically cover male methods of contraception or require high cost-sharing despite the critical role men play in the prevention of unintended pregnancy. The CCCA closes this gap in current coverage requirements to cover male contraceptive methods without any new mandates or costs to the state. Vasectomies are among the most effective and cost-effective contraceptive methods available; and are less invasive and carry fewer risks than female sterilization. Limiting insurance coverage of contraception to female methods only creates a financial incentive for heterosexual couples to put the onus of contraception onto the woman and reinforces the cultural attitude that contraception is a woman’s responsibility.
 

[10] An Intrauterine Device (IUD) is a long-term, reversible type of contraception.  
 

[11]Gavin, Loretta, et al. Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs Recommendations and Reports. U.S. Centers for Disease Control and Prevention & U.S. Office of Population Affairs (2014), available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6304a1.htm.
 

[12]Greene Foster, Diana, et al. “Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended. Obstetrics & Gynecology, Vol.117 no. 3 (2011): 566; see also, Committee on Health Care for Underserved Women. Committee Opinion: Access to Contraception, no. 615. The American College of Obstetricians and Gynecologists (2015) (Opinion supporting the provision of one year of contraception to reduce cost and improve adherence and continuation rates, and noting that “[i]nsurance plan restrictions prevent 73% of women from receiving more than a single month’s supply of contraception at a time.”)

 

 

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