Mandatory Coverage of Contraception Could Increase Use of Expensive Agents

Today’s Managing Health Care Costs Indicator is $919.86

Click to enlarge. Source: 

Full coverage of contraception should be a money-saver, as I noted in an earlier post.    However, my reading of HHS’s announcement makes me worried that the requirement for health plans to cover all contraceptives, regardless of cost, could lead to much higher use of less cost-effective birth control options.   

The new regulations require that  long-term contraceptive methods, such as an IUD, be fully covered, even though the woman might well be on a different health insurance plan a short while after receving this.  This is good from a societal point of view.  The long-term contraceptives (IUDs and depo-provera) are more reliable, since they don’t require users to take a pill or insert a device frequently. This increases effectiveness in real-world use, and these long-term agents tend to cost less over their duration than oral contraceptives.

Here's the worry with mandatory access to all contraceptives without patient cost-sharing.  There is a ten-fold difference in price between generic oral contraceptives and newer, heavily-marketed, branded oral contraceptives.   If insurance companies are mandated to cover each with no patient cost sharing, we could see a migration from cost-effective generics to newer drugs which cost far more and are not any more effective.  Further, when physicians prescribe these newer medicines, they don’t know whether broad community use will unearth side effects not recognized during limited pre-marketing testing.

My suggestion – the regulations should be clear that patient cost sharing is not allowed for generic oral contraceptives. Patient cost-sharing does lower utilization, and there are some costly medications which could otherwise increase the cost of health care.  Ideally, regulations should also set a maximum acquisition cost for longer term contraceptives to prevent massive future price increases.