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Insurers told to cover contraception in full

Half of all pregnancies are unplanned, said Paula Johnson, a member of the panel that drafted the recommendations. Half of all pregnancies are unplanned, said Paula Johnson, a member of the panel that drafted the recommendations.
By Chelsea Conaboy and Deborah Kotz
Globe Staff / August 2, 2011

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Women covered by private insurance will soon be able to fill their birth control prescriptions at no cost, the US Department of Health and Human Services announced yesterday. Starting in August 2012, insurers will be required to cover the full cost of contraception and family planning, along with seven other services aimed at preventing disease and promoting well-being in women.

The change marks a milestone in women’s health, supporters say, and it removes a significant barrier many women face in obtaining contraception. Copayments for the pill can range from a few dollars a month to $50, but doctors say the cumulative cost can be a deterrent.

Birth control opponents argue that the change will force them to subsidize free contraception, in violation of religious beliefs.

The Affordable Care Act signed by President Obama in March 2010 required that certain preventive care services, such as colonoscopies and vaccinations, be offered with no out-of-pocket costs to patients. It also directed the federal health agency to take a hard look at gaps in covered services for women.

A panel of doctors with the Institute of Medicine - the advisory group that the Obama administration asked to review the matter - last month recommended improvements to women’s coverage, and the federal health department said yesterday it had accepted that advice.

Starting a year from now, women renewing their insurance coverage will receive free screening for domestic violence, diabetes during pregnancy, and human papillomavirus in women 30 and older. They also will be entitled to at least one visit with a doctor to discuss birth control options, general health issues, or preconception counseling, at no extra cost.

Mothers who choose to breast-feed will be offered free lactation counseling and rented equipment, such as breast pumps, to help continue breast-feeding after they return to work.

The new guidelines will ensure that “no woman in America has to choose between paying a grocery bill and paying a copayment for preventive care that could save her life,’’ US Secretary of Health and Human Services Kathleen Sebelius said.

Religious employers will be able to opt out of the contraception requirement. But the opt-out provision offered little more than “a fig leaf of conscience protection,’’ said Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council, a Washington nonprofit. She said the federal health agency pretended to take opponents’ interests into account but left them with the choice of enrolling in a plan they object to on moral grounds or going without coverage.

Premiums are expected to rise with the new offerings, but federal health officials said they haven’t calculated how much.

Eric Linzer, spokesman for the Massachusetts Association of Health Plans, said his group is concerned about the financial impact.

“Despite the value, there’s always a cost associated with mandating specific services,’’ he said.

Dr. Paula Johnson, executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital and a member of the panel that drafted the recommendations, said the new guidelines signal an important change in how the federal agency approaches women’s health.

Preventive services have traditionally been designed according to men’s needs, she said.

“Women should be looked at through an additional lens, given their different biology and given the different contexts in their lives,’’ she said.

The Institute of Medicine panel said the change to birth control coverage will benefit women and children. Mothers are more likely to get good prenatal care when the pregnancy is planned, and contraception can help women avoid getting pregnant again within months of giving birth, which can increase the risk of having a baby who is too small. Half of all pregnancies in the United States are unplanned, Johnson said.

In Massachusetts, the state’s Medicaid program has long provided contraception at no cost to consumers. Until recently, state-subsidized plans for low-income people who don’t qualify for Medicaid required monthly copayment for the birth control pill of $1 to $50, depending on the brand and the woman’s income level. But those plans eliminated cost-sharing last month.

The new federal guidelines will ensure that women with low-paying jobs who have limited coverage through their employers will get contraception, said Dr. Chip Severin, chief medical officer at Codman Square Health Center.

Even small copayments can add up. His clinic works to connect women who can’t afford contraception to programs that help pay for it. But often, he said, a woman will stop taking the pill without asking for assistance.

The financial barrier “comes up, and then somebody becomes pregnant, and then it’s too late,’’ he said.

After several years of taking birth control, Lauren Echavarria stopped filling her prescription for the pill. Echavarria had good insurance coverage and a full-time job before she went to work for a nonprofit in Colombia over the summer.

When she returned in October, she was working part time for a large clothing retailer.

The company provided coverage, but she was not making enough to cover the $20 monthly copayments, she said. The 25-year-old from Boston had a serious boyfriend and the decision to stop taking the pill was stressful, she said.

She’s back on the contraceptive, after being promoted to full time with better benefits, but she said yesterday’s announcement made her glad that fewer women would have to make the choice that she did.

“It’s just one of those things you shouldn’t have to think about,’’ she said.

Dr. Susan Haas, specialty director for obstetrics and gynecology at Harvard Vanguard Medical Associates, said the change could encourage more women to adopt longer-lasting birth control methods that typically have higher up-front costs. That could reduce the number of unplanned pregnancies that occur when women are inconsistent in taking the pill.

Chelsea Conaboy can be reached at cconaboy@boston.com; Deborah Kotz can be reached at dkotz@globe.com.


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