Prescription birth control to be covered without a co-payment: What that really means for you

The U.S. department of Health and Human services announced on Monday that certain health services for women, including prescription birth control and domestic violence counseling, will now be considered preventive care and, as such, must be covered by health insurance companies without charging a co-payment.

"Prevention really does pay in the long run," Health and Human Services Secretary Kathleen Sebelius said in an interview with Yahoo! Shine today. "It's better to address issues proactively than retroactively."

The decision follows recommendations made by the Institute of Medicine in July. In addition to prescription contraceptives, the mandate covers screening for and counseling about sexually transmitted diseases and HIV, HPV screenings for women over age 30, screening for diabetes during pregnancy, support and equipment for mothers who are breastfeeding, and annual "well-woman" doctor's visits intended to identify health risk factors and coordinate other preventive services. Under the Affordable Care Act, preventive services must be covered 100 percent by health insurers.

"Too many Americans do not receive the preventive care they need and deserve," Dr. Howard Koh, assistant secretary for health in the U.S. Department of Health and Human Services, said in a press conference on Monday. "On average, women need to use more preventive services than men. But women often earn lower incomes than men, and are less likely to be able to pay, so they're more likely to forgo certain preventive serves because of cost."

About 34 million women will be gain new coverage when the changes take effect on January 1, 2013; government officials expect that number to grow as insurers launch new plans or revise older ones that are currently exempt thanks to a grandfather clause.

"If a current plan meets a series of guidelines and, over the course of time, the employer does not shift major costs onto the employees or change the benefits package to the detriment of the employees, then they can continue to operate within the framework of the law," Sebelius explained.

Birth Control pills are the most common drug prescribed to women age 18 to 44, according to data from the Department of Health and Human Services. "Not [covering birth control] would be like not covering flu shots, or any of the other basic preventive services that millions of other Americans count on every day," Sebelius said. According to Thomson Reuters-NPR Health poll, 77 percent of Americans believe that private medical insurance should provide birth control at no cost to the consumer, and 74 percent believe that government-sponsored plans should do so as well.

Even so, describing birth control as a preventive service has been especially controversial, in spite of an opt-out clause that allows religious organizations to refuse to offer contraception coverage. Only FDA-approved contraceptives that prevent implantation, including birth control injections and IUDs, are included in the mandate, Sebelius said. Opponents, however, point out that it would also include Plan B, the emergency contraception known as "The Morning-After Pill." (Though Plan B is also available without a prescription for women age 18 or older, one would need a prescription for it in order for health insurance to cover it.)

Family Research Council told CNN that the decision "undermines the conscience rights of many Americans." And the chairman of the Committee on Pro-Life Activities with the United States Conference of Catholic Bishops, Cardinal Daniel DiNardo, said: "Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible."

Birth control pills are also prescribed to treat certain health issues, from Polycystic Ovarian Syndrome (PCOS) to severe acne. Groups who have spoken out against contraceptive coverage have not addressed that side of the issue, focusing instead of the moral aspects of family planning and sparking outrage over the idea of tax-payer funded birth control.

But, as Sebelius told Yahoo! Shine, the new mandate applies to private market plans only. "There are no tax-payer dollars being used to pay for this or any other Institute of Medicine recommendations," she said in an interview. (Medicaid, which is federally funded and covers about 38 million Americans, does cover certain contraceptives but is not affected by the recommendation.)

Birth control pills currently cost $10 to $50 per month, depending on whether they're brand name or generic, and depending on the amount of the total cost covered by a patient's insurance. More than 90 million prescriptions for contraceptives were dispensed in 2009, according the market analysis firm INS health. "The vast majority of large employer plans already cover contraceptives," Sebelius added. "They may not cover it without a deductible or a co-payment, but they cover it."

Since about most major plans already pay for at least some of the prescription contraceptive's price, covering a patient's out-of-pocket costs shouldn't cause everyone's health insurance premiums to go up by much. Any increase in premiums would also be offset by savings that would come from avoiding future health problems, thanks to the 100-percent coverage of health screenings and other newly designated preventive services.

"Our financial analysts have looked at it and feel that the cost will be minimal," Sebelius said, adding that the Department of Health and Human Services does not have an exact dollar amount. She pointed out that health insurance companies would still be able to set their own cost structures, and could cover generics in full while requiring patients to pay a deductible or co-payment for brand-name versions of a contraceptive.

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