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There are many wonderful things about my home state of Maryland, but today I’m very proud to say that . The Maryland Contraceptive Equity Act of 2016 makes sure that women have insurance coverage of the specific birth control that their health care provider prescribes without out-of-pocket costs and requires insurance plans to cover up to six months of birth control dispensed at once. What’s the big deal, you ask? Read on. Maryland already has good birth control laws, but there are still barriers to birth control.
Maryland has long been a leader in taking steps to ensure access to birth control, with laws that require health plans to cover birth control when they cover other prescription drugs and that allow adolescents to consent to family planning services confidentially. These policies have gone a long way to improve access to birth control in Maryland, but barriers remain and the Maryland Contraceptive Equity Act addresses some of them.
The fact of the matter is, many women who experience unintended pregnancies were using birth control and trying not to get pregnant. These women may have not been able to use birth control correctly or consistently because of barriers to accessing it, like out-of-pocket costs or difficulty accessing a pharmacy. But, there are two key ways to reduce barriers to birth control and help women use it correctly and consistently: 1) remove cost barriers to birth control, and 2) make it easier to access birth control. And this new Maryland law does both! Women in Maryland with insurance should no longer have out-of-pocket costs for birth control.
While the federal Affordable Care Act’s (ACA) birth control benefit eliminated many cost barriers to birth control, even women eligible for this benefit may face difficulties getting coverage without cost of the specific birth control recommended by their health care providers.
That is because the ACA requires coverage without out-of-pocket costs of at least one item within each birth control method category for women, but plans can still use medical management techniques within a birth control method category, such as imposing costs on some pills while covering others without cost. Women often go without preventive health care because of costs, even small costs. So, if a plan is still charging for the specific birth control a woman has chosen with her health care provider, that cost can be a barrier to accessing the care she needs. The Maryland Contraceptive Equity Act of 2016 ensures that women have coverage without cost-sharing of the specific birth control recommended by their health care provider, facilitating women’s access to birth control and enabling them to use it more consistently. Insurance plans in Maryland can no longer arbitrarily limit how many packs of birth control a woman can get at one time.
Often health plans limit how much birth control a woman can pick up to a one-cycle or three-cycle supply dispensed at one time. This kind of limit forces women to visit the pharmacy at least once every three months, if not monthly. Getting time off from work or school or difficulty accessing a pharmacy, either because of lack of transportation or limited pharmacy hours, make this difficult for many women. These types of barriers are especially pronounced for women who rely on public transportation, whose work hours may not be predictable, or who may have difficulty getting to a pharmacy. This can prevent a woman from getting her birth control when she needs it, and she may have a gap without birth control, leading to unintended pregnancy.
However, a promising study out of the University of California at San Francisco showed that access to a full year’s supply of birth control pills can improve consistent use by helping women eliminate gaps in use. The study found that among women who received a full year’s worth of pills at one time, the odds of pregnancy decreased by 30% and odds of abortion decreased by 46%, compared to women who received either one or three packs of pills at a time. The Maryland Contraceptive Equity Act requires insurance plans to cover six months of birth control dispensed at one time, meaning that women should only have to go to the pharmacy twice a year to get their birth control. This should reduce the chances that women have a gap in birth control use and subsequent unintended pregnancy. This isn’t just about birth control – it’s about women and families’ economic well-being.
On its face, this law removes unnecessary barriers to birth control and enables women to use birth control more effectively. But there’s so much more that it does. Improving women’s ability to prevent unintended pregnancy has a real impact on women and families’ long-term economic well-being. Birth control access is linked to women’s greater educational and professional opportunities and increased lifetime earnings. In fact, increased access to birth control is one reason the gender wage gap closed in the last few decades of the 20th century.
So, today, Maryland women should break out the Old Bay, crack open a Natty Boh (or Flying Dog if you prefer), and celebrate with a toast to this new law!