I found myself on a late night pharmacy run this week to refill my birth control—yes, I’m a procrastinator—but when the pharmacist told me the prescription would cost $99, my blood pressure hit the roof. I was used to having a $20-30 co-pay, but $99.44, to be exact? Anyway, isn’t it supposed to be free?
My husband settled into one of the chairs near the prescription counter: This problem wasn’t going to be resolved quickly.
An hour later, after heated phone calls with Aetna reps regarding my benefits, I learned that I had two options: I could go home empty-handed, with the increased risk of expanding my family, or pay $100, toward my deductible, to pick up Lo Loestrin Fe through my company-subsidized health plan. I chose the latter and found an online coupon to shave quite a bit more off the cost. In the end, I left Walgreens with my pockets only $33 lighter, just as angry, and with one burning question: Was this normal?
According to my very unscientific survey, five out of seven of the women I know are still paying for some form of birth control. Even though the Affordable Care Act, or “Obamacare,” as some call it, provides access to co-pay and deductible-free contraceptives for most women. Just this week, the Obama Administration clarified mandates outlined in the act, to make certain insurance companies are fully aware of their responsibility to cover one of each of the 18 FDA-approved birth control methods in each category. “That means pills, patches, rings, shots, implants, different kinds of IUD’s, sterilization, and a couple others,” said Mara Gandal-Powers, a health and reproductive rights lawyer for the National Women’s Law Center in Washington, D.C.
“But why were my pills still $99?” I asked.
“There’s a couple different things that can be going on,” said Gandal-Powers.
“There are some employer-based plans where the health care law hasn’t kicked in yet. It’s what we call being grandfathered,” Gandal-Powers explained. According to healthcare.gov, a plan is grandfathered if it was purchased on or before March 23, 2010, the day the Affordable Care Act was signed into law, and legally exempt from many of the changes outlined in the reform bill, at least for now. If you have this type of plan there’s a chance it could change after the upcoming open enrollment period. “Know when you’re going to hit a new plan year and see what happens with your coverage then,” advised Gandal-Powers.
My plan wasn’t grandfathered, but Lo Loestrin Fe is a brand name medication, not a generic, hence the $99 bill. My health plan does cover more than 100 generic birth control pills, but none with the exact prescription combination in Lo-Loestrin Fe, the drug prescribed by my doctor.
Here’s the good news insurance companies may not tell you: Women can still receive brand-name prescriptions at no-cost by utilizing a waiver called the expedient exceptions process, if the doctor determines that a specific medication is medically appropriate for you. “[It’s] something that quickly gets you what your healthcare provider says you need,” Gandal-Powers pointed out. “I think that’s really important both for women and for health care providers, to know that they can make a choice and say that this is what she needs and the health care plans have to listen to that,” she said.
If your plan isn’t grandfathered and you realize you’ve been paying for contraceptives that you should have received for free, you can always submit an appeal or reimbursement to your insurance company for the amount you’ve paid. “Even if it’s not very much every month, it adds up,” said Gandal-Powers. And if you feel comfortable enough, there’s also the option of addressing the issue with your company’s human resources department, which has the power to put pressure on the insurance company if employees are being denied. “I think it’s great and really helps facilitate the process of making sure your plan is doing the right thing,” said Gandal-Powers.
All in all, it was one frustrating pharmacy experience, but I learned two important lessons: Free contraceptives are available. And there are resources to help women access them, no matter the situation. If you’re still paying for birth control, use this flow-chart to figure out if your health plan is grandfathered and call the CoverHer hotline at 1-866-745-5487 for free help on everything from filing an appeal to reporting inappropriate behavior by your insurance company.