Contraceptive coverage: Is it headed your way?
How many of your patients have insurance coverage for contraceptives? Get ready to see more of them, as 20 states have passed legislation requiring health plans to pay for contraceptive products.
New York, Arizona, and Massachusetts are the latest states to enact contraceptive coverage laws.1 Most laws require health insurance policies that cover prescription drugs to pay for contraceptives. Some states, however, include an exemption for employers who object to such coverage for religious reasons. (See listing in table below.)
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States that Have Coverage Laws |
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| Source: www.covermypills.org. |
States with contraceptive equity bills pending include Alaska, Florida, Illinois, Michigan, Nebraska, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Utah and Wisconsin, according to www.covermypills.org, the Internet headquarters for the Fair Access to Contraception project. The project, sponsored by the Seattle-based Planned Parenthood of Western Washington and the New York City-based Planned Parenthood Federation of America (PPFA), includes a coalition of supporting organizations committed to contraceptive equity.
Action to spur contraceptive coverage has moved forward not only on the legislative scene, but in the courts as well, according to Eve Gartner, senior staff attorney at PPFA. A hearing is scheduled this month to consider a tentative settlement reached in the Erickson v. Bartell case, filed in July 2000 in the U.S. District Court of Western Washington.
Suit alleged sex discrimination
The lawsuit, initially filed on behalf of Jennifer Erickson, RPh, a pharmacist employed by the Seattle-based Bartell Drug Co., alleged that it is sex discrimination for an employer to exclude prescription contraception from an employee health plan that covers other prescription drugs. The federal court ruling, issued in June 2001, was the first to follow the landmark 2000 decision by the federal Equal Employment Opportunity Commission (EEOC), which called for companies to provide coverage of prescription contraceptives if their group health plans pay for other prescription medications.
Other class-action lawsuits have followed, claiming similar violations under Title VII of the Civil Rights Act. Title VII law prohibits companies with 15 or more employees from making decisions on the basis of gender or pregnancy, or other discriminatory reasons. Since women are the sole users of prescription contraceptives, the lawsuits contend an employer’s refusal to cover the methods constitutes sex discrimination.
One of the largest class-action lawsuits includes one filed against the Wal-Mart retail chain; the Bentonville, AR-based company has 1.4 million employees nationwide, the majority of whom are women.2 The complaint, which still is pending, was filed on Oct. 16, 2001, in the Northern District of Georgia. It alleges that Wal-Mart’s practice of excluding prescription contraceptives while providing coverage for other prescription drugs and devices violates federal law. The lawsuit includes all female employees of Wal-Mart nationwide who are covered, or who have been covered, by the company’s health insurance plan at any time after March 8, 2001, and who used prescription contraceptives during the relevant period, says Jennifer Schirmer, Esq., of the New York City-based legal firm Milberg Weiss, which is representing the plaintiffs.
Check what’s covered
An increasing share of insured workers have coverage for oral contraceptives, according to a national survey of more than 3,200 public and private employers. In 2002, 78% of covered workers received coverage for oral contraceptives, up from 64% of workers in 2001, survey results indicate.3
Coverage for the Pill varies between different types of insurance plans, survey findings show. Employees in HMO plans are the most likely to have coverage for oral contraceptives, but many in preferred provider organizations and point-of-service plans also receive assistance with contraceptive costs.
Gartner confirms that employers are voluntarily covering contraception much more than they were five years ago. However, it is important to note exactly what costs are being provided for in employee health plans, she says. While coverage of oral contraceptives is important, other methods should be included as well, she notes.
"What the EEOC required, and what the district court in Seattle required, is that health plans, in being nondiscriminatory, have to cover every method," she states.
References
1. Sidoti L. More states pushing contraceptive coverage. Boston Globe, Dec. 21, 2002:A2.
2. Schoolcraft LR. Wal-Mart dealing with contraceptive suit. Atlanta Business Chronicle, Dec. 20, 2002: accessed at atlanta.bizjournals.com/atlanta/stories/2002/12/23/story4.html.
3. Henry J. Kaiser Family Foundation. Latest Findings on Employer-Based Coverage of Contraception. Menlo Park, CA; Aug. 7, 2002. Accessed at: www.kff.org/content/2002/3256/.
How many of your patients have insurance coverage for contraceptives? Get ready to see more of them, as 20 states have passed legislation requiring health plans to pay for contraceptive products.
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