Not to be outdone by Republicans who say they support expanding “access” to contraception by making birth control available over the counter, Senate Democrats unveiled a proposal Tuesday to make sure that if that does happen, women can still get birth control through their insurance without paying extra.
Sen. Patty Murray’s (D-WA) Affordability Is Access Act would require insurance companies to cover birth control pills without cost-sharing from patients if the Food and Drug Administration (FDA) decides they can be made available without a prescription.
The bill has at least 28 co-sponsors in the Senate, including Sens. Barbara Boxer (D-CA), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Harry Reid (D-NV), Jeanne Shaheen (D-NH), and Michael Bennet (D-CO). All of the co-sponsors are Democrats except for Sen. Bernie Sanders (I-VT), who caucuses with the Democrats.
Murray introduced the bill to reporters on a Tuesday press call with representatives from Planned Parenthood, NARAL Pro-Choice America, and the American Congress of Obstetricians and Gynecologists (ACOG), all of whom strongly support the legislation.
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“Access to birth control doesn’t mean much unless it’s affordable access,” said Planned Parenthood president Cecile Richards on the call. “You can make birth control available over the counter at every pharmacy in America, but if it still costs $600 a year, it will be out of reach for many women.”
Only the FDA has the power to make medication available over the counter, but that didn’t stop Sen. Cory Gardner (R-CO) from promising on the midterm campaign trail that he would fight for over-the-counter (OTC) birth control if elected to Congress. He kept that promise by introducing a bill last month designed to encourage birth control manufacturers to apply for OTC status.
Women’s health advocates and health-care providers weren’t impressed, calling the bill a “sham” and a cynical attempt to undermine the no-copay birth control benefit.
“Anti-choice politicians have wanted to repeal the ACA—they’ve tried every trick in the book—and to force women to pay the full price of their birth control on top of what we pay for our health insurance premiums out of pocket,” said NARAL president Ilyse Hogue on the Tuesday press call.
Advocates say Gardner’s bill is part of an effort to distract from his extreme anti-choice record by letting him claim he wants to expand “access” to contraception, a term more typically used by pro-choice supporters of the Affordable Care Act (ACA).
“This Republican approach of access without affordability is like offering somebody a single shoe,” Murray said on the press call. “You really need the pair.”
The ACA requires insurers to cover all forms of birth control without copays, but that requirement only applies with a doctor’s prescription. Unlike the Democrats’ bill, the Republican proposal doesn’t change that in the event that birth control gains OTC status, which could mean that women with insurance would pay extra if their preferred birth control went OTC and their insurance stopped covering it as a result. The GOP bill would also restrict over-the-counter contraception to women over the age of 18.
“What we’re saying with this legislation is, if you’re paying for your insurance, you shouldn’t have to pay twice,” Murray said.
Unlike the Republican proposal, Murray’s bill doesn’t offer any specific mechanism to try to make birth control go OTC any faster. The GOP bill tries to give pill manufacturers an incentive to apply to the FDA for over-the-counter status by offering a priority application review and a fee waiver, but some observers don’t think those incentives will work.
“I think we have to be very careful not to put political pressure on the FDA to approve drugs without going through the regular process,” Murray said when asked by Rewire about why her bill doesn’t include similar incentives.
“Having said that, I think that we are making progress. I do expect at some point that birth control will be offered over the counter,” Murray added. “And in that case, when that happens, our bill makes sure that insurance companies still cover it.”
Uninsured women would presumably still have to pay for OTC birth control, but they at least wouldn’t have to pay for doctor’s visits or take time off of work to schedule them, which would make them more likely to use contraception.
A recent study in the journal Contraception found that interest in OTC pills is high and that the benefits could be great, especially for low-income women.
Over-the-counter birth control pills could result in up to 25 percent fewer unintended pregnancies—as long as there are no out-of-pocket costs. Women’s use of contraception “varies widely” depending on the out-of-pocket pill pack cost, the study’s authors note.
For this reason and others, ACOG president Mark DeFrancesco said on the call, over-the-counter birth control access has many more plusses than minuses. DeFrancesco came out against the Republican OTC proposal, but supports over-the-counter birth control in general.
“Overwhelming evidence supports the safe and effective use of oral birth control without a prescription,” DeFrancesco said. “No medicine is without risk, but oral contraceptives have similar or lower risk of side effects than other types of medicines that are already available over the counter.”
DeFrancesco also said that he wasn’t worried about women not coming in for routine gynecological exams if the exams aren’t required for birth control access.
“I don’t think this will lead to a lot of people wholesale ignoring their health,” DeFrancesco said. “I think women are smarter than that, and I think they come to see us for good health care, and not only for that prescription.”