That is, will the availability of free contraception through health insurance cause women to spend more than they otherwise would, now that it’s Other People’s Money?
I had observed the other day that the actual goal of declaring all contraception Free! Free! Free! seems to be to move more women onto the IUD and implants because of their lower risk of user failures.
Are these methods actually cost-effective, over time? In principle, if the Mirena IUD costs approximately $1,000, and lasts for 5 years, then that’s $200 per year, or $17 per month, which is, from what I understand, a good deal. Only if IUDs become the norm, even for women who are not good candidates and seek to have them removed early in the five-year period does it become expensive.
What about brand vs. generic? I came across guidelines from a major insurer, in looking for details the other day, which indicated that they will only provide brand-name pills if a doctor certifies that a patient has unacceptable side effects in using the generic. (Whether doctors do this for any patient who requests it, I don’t know.)
What about barriers vs. hormonal methods? My guess is that people choose one or the other based on personal preference rather than cost. Will there be women who aren’t in sexual relationships but want to keep their options open, or are in a long-distance relationship, who will choose a pill now, even if they hadn’t before, because it’s free (and perhaps because of desirable side effects, like regular or no periods)? It seems likely to me.
Here’s the irony: the one set of users who could potentially take advantage of the Free! Free! stuff in a moral-hazardly sort of way are fertility-awareness method users. There are a number of devices which have been approved and are in use in Europe, such as the Persona fertility monitor, on Amazon for GBP 55, plus GBP 10 for an 8-pack of refill test strips. The concept here is similar to the ovulation test kits that couples can buy when they’re trying to conceive, but with, of course, the reverse guidance, and is certified, in the UK, as 94% effective at avoiding pregnancy.
Why this hasn’t been approved by the FDA isn’t clear to me; I don’t know whether the manufacturer simply never thought it would be worth the effort, or if the FDA’s guidelines mean that it wouldn’t meet some criteria or another (such as being idiot-proofed) for contraception.
But if it were approved, this would be a significant market, and a potential movement from low-tech charting to an ongoing expense every bit as high as the pill.
Second question: is there a risk that contraception manufactures will determine that they can now increase their prices as much as they wish, especially for single-source drugs and devices, like the Mirena or the implants? After all, if the insurer is required to cover Mirena, then they’d be trapped, right? I suppose time will tell, but I wouldn’t be surprised if the pricetag starts increasing, with, as seems to be the case often enough, special price reductions for the uninsured, to soak up as much of the insurance premium as possible.
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