State Legislation Focuses on Contraceptive Access
Reproductive health services safeguard and promote public health by reducing unintended pregnancies, pre-term births, and infant mortality, as well as potentially helping to address child poverty and other important determinants of health. While ACA changed national policy for contraceptive coverage, states also play a critical role in expanding access to contraceptives for their residents. ASTHO is currently tracking a variety of state legislation that expands access to contraceptives through insurance coverage requirements, allows pharmacists to dispense contraceptives, and supports the use of long-acting reversible contraceptives methods.
Most insurance companies cover one to three months of prescription drugs at a time. However, evidence suggests that receiving a longer supply of birth control pills leads to improved drug adherence and fewer unintended pregnancies. Currently, California, Washington, Oregon, Hawaii, Illinois, and Vermont require coverage for a 12-month supply of birth control pills. In addition to the 12-month supply mandate, California, Illinois, Maryland, and Vermont require insurance plans to cover all “FDA-approved contraceptive drugs, devices, and other products” without cost-sharing. The map below shows the states that have enacted or proposed legislation extending insurance requirements for contraceptives.
Allowing pharmacists to dispense self-administered contraceptives is another way states are expanding contraceptive access. Currently, California and Oregon have laws in place to allow pharmacists to dispense contraceptives, and Tennessee and Washington allow pharmacists to dispense some forms of contraceptives through collaborative practice agreements. In 2017, legislatures in at least 13 states are considering bills to either allow pharmacists to dispense contraceptives or to further study the issue. There is some variation in how states structure this access in terms of training requirements and protocols for pharmacists, whether an initial prescription is required, whether access is restricted to individuals over 18 years old, and whether it applies to all self-administered contraceptives or just birth control pills.
Finally, states are seeking to improve access to and availability of LARC methods. Oregon and Vermont are considering bills to allow the state Medicaid agency to reimburse for immediately post-partum LARC insertions. This intervention has the potential to reduce unintended and short-interval pregnancies. In Connecticut, HB 6180 creates a pilot program to provide free LARC to 1,000 Medicaid recipients in the state. In Massachusetts, a bill (SB 507) sets out insurance reimbursement rates for LARC and requires the health department to conduct provider training and reduce barriers to same-day procedures. Tennessee has two bills establishing a program to train providers on non-coercive counseling strategies, LARC insertion and removal, and administrative and technical issues such as coding, billing, and pharmacy rules. In addition, the state health department can provide general financial support to provide and stock LARCs to ensure same-day access, provide general outreach and education, and conduct a study on making contraceptive methods available over-the-counter or directly through pharmacies. A Wyoming bill (SF 150) allows the state health department to provide LARC as part of family planning services. Although the bill does not appropriate general funds, it encourages the health department to apply for grants and other sources of funding. Finally, in New Jersey, a bill (SB 2918) requires the Department of Human Services to implement a Medicaid payment strategy to “optimize the availability of long-acting reversible contraceptive.” The bill identifies reimbursement for immediate postpartum LARC insertion as well as removing administrative and logistical barriers to timely, patient-centered LARC provision.
To learn more about state activities, register for Expanding Contraceptive Access: Developing and Implementing State-Based Approaches. This webinar, co-sponsored by ASTHO and the Network For Public Health Law, will highlight innovative strategies and programs underway in state health departments that target key populations and ensure access to the full range of reproductive health services, including legislation requiring two- and four-year colleges to develop plans of action to address unintended pregnancies among 18- and 19-year-olds, as well as the use of incentive metrics for coordinated care organizations to increase access to contraception.
Note: ASTHO does not take a position on state legislation and bills mentioned in this blog should not be considered endorsed or opposed.
KT Kramer, JD, MHA is ASTHO’s director of state health policy. She supports state and territorial health agencies to advance and strengthen public health
through laws and policies.