Medicaid and Emergency Contraception
Medicaid and Emergency Contraception The Low Income Access Program’s new memo, entitled, Expanding Medicaid Coverage for EC on the State Level, provides an overview of current states coverage of EC and gives a number of advocacy strategies groups can take to expand coverage in their own state. This memo should be used in conjunction with National Health Law Program’s new report, Over the Counter or Out of Reach? A Report on Evolving State Medicaid Policies for Covering Emergency Contraception (June '07) Background: Emergency contraception (EC), also known as the “morning-after pill,” is a hormonal method of birth control that is taken to prevent pregnancy after unprotected intercourse. EC can be taken up to five days after intercourse, but is considered most effective if taken within 72 hours after sex. Plan B, a dedicated product of EC, was first approved by the US Food and Drug Administration (FDA) in July 1999 as a prescription-only medication. From 1999 to 2006, advocates and experts pushed for the FDA to approve Plan B as an over-the-counter medication due to its time limit on effectiveness. EC Over-the-Counter Access: After years of advocacy by women’s reproductive health advocates, the FDA finally granted over-the-counter (OTC) access for Plan B on August 24, 2006 for women 18 and over. However, the FDA decision did not make OTC EC available and accessible for all women. Three groups of women have been excluded from the benefits of timely access: Young women under age 18 Women, particularly immigrant women, who do not have a government-issued ID to prove their age Low-income women who cannot afford the drug and whose Medicaid plan does not cover OTC EC
Reproductive health advocates must continue to work to expand EC coverage for all women. In our report, we focus on how to expand access for low-income women on Medicaid. Low-income women on Medicaid are excluded from access to OTC EC because most state Medicaid programs still require them to have a prescription. This is needed because most states’ Medicaid billing procedures require a pharmacist to submit a prescription in order to be reimbursed. Women on Medicaid are therefore forced to either pay out-of-pocket or obtain a prescription from their doctor in order to obtain coverage. For women who wait to obtain a prescription, those few extra hours or even days can decrease the effectiveness of EC. For those that are forced to pay out-of-pocket, the average cost of $40 can be prohibitive. States must expand Medicaid coverage for EC so that low-income women do not have to pay more or wait longer than others to obtain EC. This memo outlines how eight states have already addressed this problem by changing their Medicaid policies to cover OTC EC. Many of these states have decided to pay for this new coverage with their own state dollars, while several have established policies that allow them to still receive federal reimbursement. At the end of the memo, a set of recommendations have been provided for advocates to help ensure low-income women have access to this important method of birth control in their own states.
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