Insurance: Insurance Coverage Might Steer Women To Costlier — But More Effective

In the heated debate over the extent to which religiously affiliated employers should be obliged to provide free contraceptives to workers, nobody has talked much about what methods are available for women wishing to avoid pregnancy and how their choices may alter himself, whose costs were removed from the equation. But it is an important issue.

With prices starting around $ 1 for a condom to more than $ 800 for an intrauterine device (IUD), some of these women, many of them may or may switch methods if they could afford. That's exactly what many women's health advocates hope. Long-acting methods such as IUD and hormonal implant is almost 100 percent effective, requires no effort after the insertion of and protection against pregnancy for up to 10 years. (In contrast, the oral contraceptives approximately 92 percent efficient, and many other conventional methods are even less reliable in daily use.) Some women care to have a device inserted in the uterus or under the skin is more risky than methods such as a pill, a patch or a vaginal ring, they can stop at will.

But experts like Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a nonprofit research center on reproductive politics, pointing out that the IUD and implants "eliminate the possibility of inconsistent use."

They are also among the most cost effective methods available in the U.S., according to research by James Trussell, a professor of economics and public affairs at Princeton University. Among other things. Trussell included in the price of certain techniques, their effectiveness at preventing pregnancy, and the costs of unwanted pregnancy or other events over a five-year period IUD and vasectomies proved to be the most cost-effective. Implants were somewhat less cost, but still a better bet than the pill, the patch, the vaginal ring, or injectable contraceptives, among others.

These longer-acting methods but carry a hefty upfront cost between $ 500 and $ 1,000 for the equipment itself and its insertion. Meanwhile, insurance coverage is uncertain. Although the vast majority of employer health plans cover contraception, they do not necessarily cover all the methods and they generally do not cover them for free. A 2004 study found that 40 percent of the companies covered IUD.

"For most plans, the units that are not considered part of the drug formulary so you can have some coinsurance amounts, as 20 percent," Sonfield says.

Health Care Reform

Under the new health care law, starting in august, new employer health plans or those who change their benefits will significantly be required to cover all FDA-approved contraceptive methods and related counseling without co-pays. Catholic bishops and others strenuously objected to the introduction of this requirement on employers who protested against contraception on religious grounds. Obama administration last week offered a compromise that would allow women who work for religious organizations to get contraception directly from an insurance company - still no co-pays. But the debate continues.

Even removing the cost concerns may help to promote the use of longer-acting methods, it is only half the battle. Training women and providers is also critical, experts say. Many people still associate with the Dalkon Shield IUD, a device marketed in the early 1970s that led to serious infections, sterility and death, resulting in hundreds of millions of dollars in legal
requirements.

"The Dalkon Shield put a chill on the IUD for the next four decades," says Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico.

Only 5.5 percent of women practicing contraception used an IUD in 2006-2008. An even smaller percentage used hormonal implants, which received FDA approval in 2006. In contrast, use 28 percent of women the pill.

The long-acting, which is currently approved by the FDA are considered safe and effective. They include two spirals and Mirena and ParaGard. These small T-shaped devices are inserted into the uterus and the release of hormones or small amounts of copper to prevent fertilization in the five or ten years, respectively. Implanon is a matchstick-size hormonal implants, once inserted beneath the skin of the upper arm, prevents pregnancy for three years.

Education Effort

The contraceptive potential project is to test the idea that by educating women about the long-acting methods and eliminate the cost barriers, more decide to use them, and fewer become accidentally pregnant.

In 2007, the researchers at Washington University in St. Louis to enroll 10,000 women in the region and offer them for free contraception of any kind for three years and focuses on educating them about the long-acting methods.

Seventy-five percent chose IUDs or implants, a much higher degree than 5.5 percent in the general population. After a year, decided 86 percent of those who use IUDs or implants to continue with long-acting method, only 55 percent of the women taking the pill continued with this method, according to preliminary figures from the researchers.

"Women should be able to control their reproductive lives," says Jeffrey Peipert, principal investigator for the project, who is vice chairman for clinical research in the Department of Obstetrics / Gynecology at Washington University School of Medicine. "But with our current system is so many people are uninsured or unable to pay for their birth control." Lydia and Drew Huston has three children, and do not want anything more. As Lydia, now 44, heard about the research at the university near their home in Florissant, Mo., she enrolled. Three years of free contraception sounded like a good idea. Until she was in the studio, Huston had been getting hormonal Depo-Provera shots every three months to prevent pregnancy. Her co-pay was $ 20 each time. Although it was better than having to take a pill every day to get to the doctor once every three months were hard given his family responsibilities and her job to work in the development of a nonprofit organization.

Before meeting with university researchers, Huston never understood the long-acting opportunities that were available. "They gave me this array of information," she says. "It was so empowering." After discussing methods, Huston decided on a hormonal implant that will last for three years. It was an easy transition from the injections she had received earlier.

Huston is happy with her choice. "Knowing what I know now, if I had to pay for a longer-acting method, I would."

It is a choice many women like Huston soon will not have to do.

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Tuesday, February 21, 2012

Insurance Coverage Might Steer Women To Costlier — But More Effective — Birth Control

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