Making Over-the-Counter Oral Contraceptives Affordable: A Roadmap
Ensuring affordable access to over-the-counter contraception is essential.
Media coverage | Momentum is building for otc affordability | federal action | white paper - otc contraceptive coverage
MEDIA COVERAGE ON AFFORDABILITY
stat op-ed: “a roadmap for making over-the-counter birth control affordable,” by cai co-founder dana singiser
…Over-the-counter affordability includes four elements: rules regarding contraceptive insurance coverage under the ACA, adjustments to government-run insurance, a low retail price, and accommodation for those without insurance who cannot afford to pay out of pocket.
…The FDA’s approval of over-the-counter access to one of the most reliable and popular forms of contraception is a monumental breakthrough in the continuous uphill battle for substantive reproductive health care. And the government has a responsibility to ensure that not just access to but also affordability of reproductive health resources is fully cemented for all folks, irrespective of race or gender or economic status, as affordability is truly key to fully realizing the health and equity potential of the FDA ruling itself.
The ACA enabled millions of women to get access to free, reliable contraception. The country is ready for the next step toward equity: no cost over-the-counter contraception.
HEALTH AFFAIRS forefront OP-ED: “Approved, But Not Covered: How Insurance Coverage Is Essential To Achieve The Health And Equity Benefits of Over-The-Counter Contraception,” by Erin E. isenberg, MD and A. Mark Fendrick, MD
THE PROGRESSIVE MAGAZINE OP-ED: “IT’S TIME FOR NO-COST BIRTH CONTROL,” BY RAEGAN MCDONALD-MOSLEY, MD, MPH, CEO OF POWER TO DECIDE AND CAI’S CHIEF MEDICAL ADVISOR
Together, we have the power to bring about change. The struggle for no-cost birth control is a collective one, requiring our active engagement. We can raise our voices, assert our rights, and stand in solidarity with all those still denied access.
MS. MAGAZINE STORY: “WHAT WILL BE THE COST OF THE FIRST OVER-THE-COUNTER BIRTH CONTROL PILL?,” BY WAKABA OTO, FEAT. QUOTES FROM RACHEL FEY, VICE PRESIDENT OF POLICY AND STRATEGIC PARTNERSHIPS, POWER TO DECIDE
“The first step is having Opill on the shelf at what we hope will be an affordable price for many, but with a recognition that no price will be affordable for all,” Fey said.
POLITICO STORY: “FOUR QUESTIONS AS BIDEN ADMIN CONSIDERS OTC BIRTH CONTROL COVERAGE,” BY LAUREN GARDNER, FEAT. QUOTES FROM CAI CO-FOUNDER DANA SINGISER
Singiser said the Biden administration should ‘think creatively’ about different ways consumers could ensure Opill is fully covered at the point of sale, such as issuing a unique debit card or creating an electronic payment system that connects the purchase to an insurance plan. As a last resort, Singiser said insurance plans should ensure their reimbursement processes are consumer-friendly. Accessibility over the counter is not equitable if it’s not actually affordable, she said, adding: A policy on a piece of paper that is not workable in the real world is simply not adequate.
MOMENTUM IS BUILDING FOR OTC AFFORDABILITY
December 2023:
Nearly 200 comments are submitted in response to the federal government’s Request for Information (RFI) concerning insurance coverage for over-the-counter contraception, including CAI, the Family Planning Coalition, the Free the Pill Coalition and Dr. Fendrick and associates.
November 2023:
The Contraceptive Access Initiative launches the first advertising campaign in favor of insurance coverage for over-the-counter oral contraception.
October 2023:
Congressmembers urge the Biden Administration to clarify that federal and state-regulated private health plans must include coverage of OTC contraceptive products.
Senators urge the Department of Defense to cover over-the-counter birth control in health coverage for military families.
September 2023:
Three federal agencies issue a Request for Information (RFI) that solicits comments on potential coverage for certain over-the-counter products, including oral contraception.
August 2023:
STAT publishes a groundbreaking op-ed by Dana Singiser presenting a roadmap for true over-the-counter contraceptive affordability. Health Affairs publishes an op-ed by Dr. Fendrick calling for insurance coverage for over-the-counter oral contraception.
June 2023:
The Biden administration issues an executive order calling on three federal agencies to consider new action to ensure affordable contraceptive access, including “identifying promising practices” that would allow for no-cost, over-the-counter contraception.
May 2023:
The Affordability is Access Act is re-introduced, which includes expanding insurance coverage to contraception available over the counter.
FEDERAL ACTION
Health coverage in the United States falls under a wide array of regulatory bodies. Multiple federal agencies will need to exercise their respective authorities to ensure that people under various plans have coverage for OTC contraceptives. Doing so would be in line with President Biden’s June 2023 executive order that directed the Secretaries of Labor, Health and Human Services and the Treasury to consider actions “to promote increased access to affordable over-the-counter contraception.” Specifically, agencies may need to take one or more discrete steps to:
Cover a newly approved OTC oral contraceptive (for example, adding it to a coverage requirement and/or a formulary);
Eliminate any otherwise-required cost-sharing for OTC contraceptives, including an OTC oral contraceptive;
Eliminate any prescription requirement for OTC contraceptive coverage, including an OTC oral contraceptive;
Work with stakeholders such as providers, pharmacy chains and health plans to make OTC coverage work as smoothly as possible at pharmacies and via mail order; and
Provide notice to beneficiaries, providers and other stakeholders about any changes to coverage, as well as information about how to navigate and facilitate coverage of OTC contraceptives without prescription.
See additional content from CAI’s White Paper on OTC Contraceptive Coverage here as well as specific information on the following federal programs:
Coverage of Over-the-Counter Oral Contraceptives - Children’s Health Insurance Program (CHIP)
Coverage of Over-the-Counter Oral Contraceptives - Department of Veterans Affairs
Coverage of Over-the-Counter Oral Contraceptives - Federal Employees Health Benefits Program
Coverage of Over-the-Counter Oral Contraceptives - Medicare
Coverage of Over-the-Counter Oral Contraceptives - Medicaid
Coverage of Over-the-Counter Oral Contraceptives - Military Health System