August 21, 2007
Are we leaving low income women behind? The reality of EC access under Medicaid
The differences between real over the counter access to Plan B and the “behind the counter” status approved by the FDA are truly significant. But for low-income women who depend on Medicaid for their health care, those distinctions are meaningless because most of them still need a prescription to get EC. It’s hard to overstate what a tremendous barrier getting a prescription can be, especially for low income women – it may be an extra trip to a physician or waiting in line at a clinic; it could mean additional costs in clinic visits, child care, lost work, or transportation. All within 72 to 105 hours.
The Medicaid program served 7.1 million women of reproductive age (15–44) in 2003 according to the Guttmacher Institute. Under Federal Medicaid law, states can decide whether or not to cover prescription drugs – all 50 states do, and whether to cover over the counter drugs - generally all require a prescription for over the counter drugs. States also have the authority to limit access to drugs through utilization controls such as requiring prior approval of a drug from the state Medicaid agency before the pharmacist can fill the prescription – problematic for a drug that has to be taken within a short time frame; limiting the number of prescriptions – for example, Utah allows only 2 prescriptions for EC per year; and cost-sharing – which fortunately does not apply to family planning services and supplies. States also are required to cover “family planning services and supplies” but they have a lot of leeway in which services and supplies they choose to cover.
Most states covered emergency contraception when it was prescription-only, and since the FDA announcement, Plan B generally is still available with a prescription in those states. Georgia, however, now only covers Plan B for teens 17 and younger, but not for adults; Mississippi has explicitly excluded Plan B from coverage. Several states have announced that they currently or in the future will make EC available without a prescription through their state Medicaid programs including Illinois, Hawaii, Maryland, New Jersey, New York, Oklahoma, Oregon, and Washington. The nine states that have Pharmacy Access Programs (also known as collaborative agreements that allow pharmacists to dispense EC) allow women who need prescriptions to get EC directly from a pharmacist.
The National Health Law Program has just released "Over the Counter or Out of Reach: A Report on Evolving State Medicaid Policies for Covering Emergency Contraception." This guide is an important tool that low-income health advocates and reproductive health advocates can use together to demand Medicaid coverage of Plan B without a prescription in their states. It provides a clear overview of how Medicaid allows for coverage of EC, a 50-state survey of EC and over the counter drug coverage policies, and resources to find out specifically which policies in your state govern Medicaid coverage of EC. We have a real opportunity to make easy access to emergency contraception a reality for all women. It’s time to stop leaving poor women behind.
Susan Berke Fogel, J.D., is a Consultant on Reproductive Health and Rights to the National Health Law Program (NHeLP), a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities.
Posted by Bush v. Choice at August 21, 2007 1:52 PM
In my state, plan B is not covered by medicaid but a lot of colleges and universities provide it throw health services. Also, most rape kits have plan B.
Posted by: johnnaral at August 23, 2007 6:12 PM