Planned Parenthood opposes making some forms of routine birth controls available over-the-counter. For an organization that claims to be dedicated to reproductive health and access to such services, this stance on the deregulation of common, safe, and effective contraceptives seems illogical. It is.
Over-the-counter birth control would offer new options to women. Consumers would be able to see on the shelf the different products that are available, compare prices, and ultimately select the option that provides them with the best value, just as they choose products in other markets. Providers would truly have to compete for women’s business, which would lead to lower prices, more innovation, and better products. What’s not to like?
One would expect Planned Parenthood and similar organizations to celebrate new calls for easier access, but instead these groups are accusing those calling for OTC birth control of trying to limit its availability by taking away insurance coverage for contraception. A controversial mandate pursuant to the Affordable Care Act requires that nonexempt insurance plans cover all FDA-approved forms of contraception from the first-dollar. This means insured women pay no copay when they pick up their prescription contraceptives.
First, even if some birth controls were offered over-the-counter, this would not preclude insurance carriers from offering first-dollar insurance coverage for them. For example, “Plan B” emergency contraception is already available over the counter, yet the insurance coverage mandate still applies to this morning-after pill. Isn’t it a little strange that “Plan B” is available without a prescription, and yet “Plan A” (or normal, before-the-fact birth control) is not?
Even if more forms of birth control were made available OTC, the insurance coverage mandate could still apply to this class of drugs, and the government insurance program for low-income women, Medicaid, could continue to finance birth control coverage as it does today (from the first dollar), sparing participating women from the (very low) cost of contraception themselves.
Yet Americans should ask if covering routine health care costs like contraception is really the best use of our insurance system. Insurance, by definition, is a contractual arrangement in which one party (the member or consumer) pays a premium for financial protection against an unforeseen loss. For example, car insurance is supposed to protect you from the costs of a major car accident, but we don’t use it to pay for oil changes or regular maintenance to our cars. Similarly, health insurance isn’t supposed to pay for every health care service, but to protect against the costs of a serious, costly disease or injury.
From this perspective, it doesn’t really make sense to cover safe, normal forms of birth control under insurance at all. And relying on a third party—our insurers—to pay for drugs like birth control pills doesn’t make them free, but rather it shifts costs from individual consumers to the insured population generally. The cost doesn’t disappear; it simply manifests in higher premiums. The HHS contraception mandate could stay in place even if birth control were available over-the-counter, but for the sake of efficiency (among other reasons), it shouldn’t.
Importantly, making contraceptives available OTC would give women greater access to these products since they would no longer have to see a doctor first. Doctors are on board with this: the American College of Obstetricians and Gynecologists supports making birth control available over-the-counter because they see the benefit of easier access and recognize that individual women are smart enough to be trusted with this safe, common drug.
If this debate were as simple as the economics I’ve laid out, nearly everyone would support over-the-counter options for birth control. But there are special interests that benefit from maintaining birth control’s status as a controlled substance.
Big drug companies benefit greatly from the Affordable Care Act’s contraception mandate. The mandate means that nearly every woman in the U.S. currently uses first-dollar insurance coverage to buy birth control. This hides the cost of consumption for her, and allows pharmaceuticals to raise the prices that insurers must pay for these products. Those costs are built into our premiums and we all end up paying more as a result. This price-shielding process also encourages the consumption of the covered products (shifting consumers away from non-covered contraceptives, like condoms, or toward the more expensive products among those covered), which can mean big profits for these companies.
Planned Parenthood’s stance on expanding access to birth control may be illogical in light of their mission statement, but it is perfectly logical when you consider the group’s financial interests. Planned Parenthood rakes in $1.2 billion annually; more than a third of their services involve providing contraception to women (and billing third parties for those costs). As a major provider of birth control and the nation’s number one abortion provider, why would Planned Parenthood support other options for women? The group is simply serving its own self-interest, trying to hang on to the status quo that leads to big business and big dollars for them. Who’s working against women now?