K. is a 32-year-old patient of mine who "absolutely loves" her LoEstrin-24 birth control pill. She told me her periods were regular, her cramps were gone, and her face was clear on this new pill. So I was surprised when K. asked me to switch her to a different pill. "I can't afford it anymore," she said. "Even with insurance, my copay is $30 a month, and it's just too much."
K.'s story reminded me how cost can be a huge factor in birth control decision-making. Even if you have insurance, copays for the newer brands of pills can be high--and some forms of contraception, like IUDs, are often not covered at all. And if you don't have insurance, your options are even more limited. While creativity and large discount stores can help, many of my patients really struggle each month to stay on their method despite tough financial times.
Which is why it's so galling to me that the Republican nominee for president is flummoxed by the idea of comprehensive contraceptive coverage, on par with coverage for drugs like Viagra. Prevention of mistimed pregnancy is one of the most important parts of a woman's health, for many years of her life. For many reasons, using a birth control method consistently can be a challenge for many, so we should remove as many barriers as possible. I'd love to see the pill available over-the-counter for $1 a month, but I'd settle--for now--for universal insurance coverage.
Have you ever made a birth control decision based on cost?
With the medical plan I have, prescriptions aren't covered until I meet my deductible (and since I've had no medical expenses this year, my deductible is still unmet), so my pills cost $60 a month, which I currently can not afford (thanks exorbitant gas prices). I was just having a conversation with one of my girlfriends about the viagra comparison, which is really pretty insulting.
$1 a month? Don't be such a tightass conservative. I'd like to see the government pay me to make responsible birth control decisions.
I definitely have. I loved the freedom of the Nuva Ring and my boyfriend liked the extra stimulation when we were having sex, but my copay was $30 a month. I've since reverted to the combined pill, which, now that I live in London near a walk-in clinic, is free, along with condoms, STI testing, and other sexual health care. The NHS may have its issues, but it's lovely to know that my reproductive rights aren't being challenged.
Since switching insurance, my big problem is not so much cost but convenience. I'm not allowed to refill a pill prescription until about 4 days before a pack runs out - I used to get a 3 month supply at a time.
The 4 day window is a huge barrier, and when I go on vacation I have to jump through a ton of hoops to get extra pills and pay out of pocket and then get reimbursed.
Do they think I'm going to OD on birth control?
I tried writing a comment on this yesterday, but it was entirely too long. Suffice it to say that I've struggled with making birth control decisions based on cost since I was 18. It's absurd to think that I've been on my mother's hospital employee (she's a physician) BC/BS plan all that time! At one point, I was paying almost $50 a month for Estrostep, which is a pill that worked very well for me. Time and time again, I've gone back to condoms as my only form of birth control. They are cheap (we get them in bulk from Condom Depot, an excellent website) and, so far--knock wood--haven't failed. Times of increased stress lead me to go back on the pill, just for the sake of peace of mind. I'm currently using samples of Yaz that my gyno gave me. It's a tier 2 on our plan; fingers crossed for a copay less than $30!
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Man, I WISH my birth control was only $30 a month! I used to pay a $25 copay, but I had to switch pills because they were making me throw up all the time. Now I'm on Ortho-Novum, which I love, but my insurance doesn't cover it and I pay $50 a month. That's $600 a year to not get pregnant.
I have spent the last 20 years making decisions about birth control based on cost and availability. I would LOVE to get an IUC, but can't afford it, and my insurance doesn't cover it at all. Insurance covers Viagra, but not birth control. How stupid is that!? I think the PTB (Powers That Be) WANT women to lose their choice, lose their ability to control reproductive decisions, get out of the work force and back into the kitchen, to ultimately fulfill a fantasy they have of the "good old days." Sigh.
I live in France where a 3 month supply of a basic birth control pill costs me only 5 Euros (no copay or anything, I just pay up front, at regular pharmacy). Even with the awful exchange rate, that's doing pretty well. Packaging is minimal, but who needs it anyhow. So I have to wonder, why couldn't I get the same prescription for less than $20 a month in the USA? Somebody is getting rich.
Part of it is due to the socialized medicine here, and some price controls, but at least a person making minimum wage here can afford to stay on the pill if they desire.
I live in Canada, where socialized medicine has done some good things for birth control. Aside from the free clinics, every brand of birth control (as far as I know) retails for less than $20 a month. Before I switched to the Mirena IUS (Best $100 I ever spent, and best $275 my insurance company ever spent either -- being as it lasts five years) I took triquilar, triphasil and alesse, which all worked reasonably well, and none of which retailed for more than $15 a month -- without insurance.
I did once make a decision for my birth control based on what was covered by my insurance and what was not- I ended up having my tubes tied with so much regret! 8 years later, divorced and remarried (the ex-husband has a new baby and he's the one that didnt want any more kids and wanted ME to have the birth control hence the tubal ligation)... now I'm 2 weeks past my surgery from having my tubal ligation reversed! And- almost 7 thousand dollars out of pocket, I might add....... so yes, IUD's etc should be covered!!! This birth control issue is just rediculous when it comes to money, why do we have to choose the cheapest way when it can sometimes break our hearts and change our lives....