Author: Morgan Devine, MPH

BETTER ACCESS = BETTER CHOICES

Birth control is a bigger part of women’s lives than most people realize, and preventing
pregnancy is just the beginning. Many turn to birth control to cut down on cramping, get
“real” sleep, or to blunt heavy bleeding (1-4). Others use it to tackle stubborn breakouts,
treat menstrual headaches or dial down mood swings (5-7). Whether it’s one of these
reasons or another, contraceptives can be a total game-changer, making women feel
more like themselves when their monthly hits.

That said, finding a birth control that is a “fit” is the challenge. It’s not just about how well
it works, but also how a birth control feels. This is an important consideration as some
contraceptives come with unpredictable side effects, some of which don’t show up the
same way in every woman. Some may battle bloating, weight gain, or feelings of anxiety
while others feel little difference at all. At the end of the day, side effects are personal,
which is why it may take “trial and error” before a woman meets her contraceptive
match (8-10).

Women Need More, Not Less

This is why women need access to a full range of birth controls with different hormones,
delivery systems, and formulations. Before a woman can zero in on what contraceptive
works best for her body and psyche, she has to have the flexibility to experience and
experiment. If the first birth control isn’t a fit, she should have the option to try another or
maybe even a few more. Why? Research shows, time and again, women who try
different contraceptives before settling on the one that is right for them, are more
satisfied, continue to use their contraceptives longer, and feel like they have more
control over their bodies (11-13). On the flip side, women who are unable to switch
contraceptives when they are not working for them often stop using their contraceptive.
In fact, nearly half of women admit to dropping their birth control in the first year of
use—mostly due to side effects (14). When selecting birth control, having a real choice
really matters.

“Trial and Error” 

The problem is not all insurance plans make this possible. When it comes down to it,
the “trial and error” journey for contraceptives can be messy and women may hit
roadblocks. While most private insurance plans under the Affordable Care Act are
supposed to cover FDA-approved contraceptives without asking patients to share the
cost, many use layers of policy like prior authorization, formularies (list of covered
contraceptives), and step-therapy rules (trial only in a pre-prescribed ordering) to limit
which birth controls are covered (15-17). For example, some insurance plans make it
difficult to change contraceptives without extra costs (18).

Another Thing, Policy Labeling

Even the classification of birth control in insurance plans matters; the labeling of birth
control can affect how women access and pay for it. Some insurance plans regard
contraceptives, including long-acting methods such as intrauterine devices (IUDs), as a
medical benefit. In the case of IUDs, the device and its insertion are billed by the
healthcare provider as a medical procedure. Other insurance plans may classify IUDs
as a pharmacy benefit, so the device has to be ordered through a specialty pharmacy
and shipped to the provider before a woman’s insertion appointment. Unfortunately, the
labeling of a contraceptive as a pharmacy benefit can lead to additional steps for
approval and potentially higher costs, depending on the insurance plan (19-21).

The Rules, State by State

In the U.S., every state sets their own birth control insurance rules. This affects what
insurance plans will cover, how many different birth controls are available, and how
much contraceptive switching is allowed depending on a woman’s location. For
example, some states are more supportive of women, making insurers provide broad
contraceptive coverage. Other states permit insurers to limit what and how many
contraceptives they cover. So, a zip code can be a determining factor in which
contraceptive a woman uses (22-23).

Too Often, Too Many Compromises

Understandably, many women have to compromise on their choice of contraception.
They tend to choose the birth control that is covered by their plan over the birth control
that is best for their health and lifestyle needs. Without question, this needs to be called
out because birth control is a bigger part of women’s lives than people realize.

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