Female hormonal birth control and how people pay for it has been controversial throughout the years. Just a few years ago the Supreme Court allowed Hobby Lobby and other companies to refrain from offering health insurance to their employees that covered the pill and other options if it their owners had religious objections. This hurt many working women who relied on the insurance from their employer to cover costs for the pill, ring, IUD, patch, etc. So while many people argue over contraception for variety of reasons rooted in religion, health concerns, sexism, the economics of how it is paid for is another aspect to consider.
Currently many women in the United States get birth control that is covered by their insurance. Because it requires a prescription, women meet with their doctors to get it prescribed, then go to a pharmacy to get it filled and have to back to their doctors and pharmacies repeatedly, depending on the length of their prescription. Health insurances pay for some to all of the doctor’s visits and the pills themselves depending on the coverage. Most insurance plans from employers, parents’ employers, the Affordable Care Act, and Medicaid cover the costs to some degree. If you were to pay for the costs out of pocket of the doctor’s visit would be almost $300 and the pills themselves would be around $50 a month.
Another option that would not require a prescription is to offer birth control over the counter. Currently many other nations including Mexico, Greece, and China have options that allow people to pick up oral contraceptives without a prescription from a doctor. The pill is currently safer than many other drugs offered over the counter and is relatively easy to use without direction from a doctor. Being able to get the pill over the counter removes many of costs, including the cost of the doctor’s appointment and high transaction costs. Transaction costs are what it costs consumers to actually but the product. In this case there are many transaction costs incurred with finding time and transportation to doctor’s appointments and trips to the pharmacy. Some women’s prescriptions only allow them to fill enough for one month. This means many trips to the pharmacy which can be especially difficult for young and low-income women who do not have access to cars or rural women with limited access to public transportation. On top of this using an insurance that a parent sees billing information can put social costs on many young women.
This makes the pill being over the counter seem like an easy answer, except the downside is many insurance companies do not cover over the counter medications. Many women would instead pay out of pocket of up to $50 a month. With prices that high most women would probably opt out and with prices at around $20 a month around half of women said they would buy the pill. There is hope around this dilemma though as many insurance companies have said they would pay for over the counter options, and even some states would require so under current laws that require condoms and emergency contraceptive pills to be covered. So, if the pill was available over the counter, many costs would decrease and some might rise depending on your current situation, coverage, and state.
The most progressive option is to have subsidized birth control that is either free, very cheap, or on some sliding scale depending on income. If there were no out of pocket costs up to an additional of around 20% of low income women would start taking the pill. Not only would this help many women out across the nation, there would be many positive economic externalities. For starters women are pretty good at deciding if and when they are fit to raise a child. Children who are born into families who are not ready can create costs for the rest of society. For every dollar the government spends on birth control, they end up saving just over five dollars in in Medicaid further down. On top of this when women are able to decide when is best to bear children for them, they are able to better invest in their own human capital and contribute more to society. All of these positive effects are stacked on top of the good it does for the women themselves and their families.
Access to birth control is crucial for individual’s lives and for development in society. What this access looks like can be tricky though. The current system of prescriptions and insurance in the United States is not the best, most affordable, or easiest for all women. While over the counter birth control sounds appealing, there are kinks that need to be worked out so women don’t get stuck paying for the pill completely out of pocket. Making the pill and other methods free or substantially reducing price could be an investment that saves money in the long run and helps out many women.
