More than half of all pregnancies in the United States are unintended, and half of all unintended pregnancies end in abortion. Contraceptives have a proven track record of enhancing the health of women and children, preventing unintended pregnancy, and reducing the need for abortion. However, although contraception is basic health care for women, far too many insurance policies exclude this vital coverage.

In fact, while most employment-related insurance policies in the United States cover prescription drugs in general, the vast majority do not include equitable coverage for prescription contraceptive drugs and devices. Similarly, while most policies cover outpatient medical services in general, they often exclude outpatient contraceptive services from that coverage. This failure is costly, both for insurers who may have to pay for either maternity care or abortion, as well as the families whose physical and financial well-being is threatened by unintended pregnancy and lack of access to equitable coverage for contraceptives.

Senator Olympia Snowe (R-ME) and Representative James Greenwood (R-PA) are sponsoring The Equity in Prescription Insurance and Contraceptive Coverage Act, to provide equity in insurance coverage for contraception. The bill simply seeks to establish parity for contraceptive prescriptions and related medical services within the context of coverage already guaranteed by each insurance plan.

Under this legislation, plans already covering prescription drugs and devices would include equal coverage for prescription contraceptive drugs and devices. Also, plans that include coverage for outpatient medical services would include outpatient contraceptive services in that coverage. The bill defines contraceptive services as "consultations, examinations, procedures, and medical services, provided on an outpatient basis and related to the use of contraceptive methods (including natural family planning) to prevent an unintended pregnancy."

 While plans routinely cover other prescriptions and outpatient medical services, contraceptive coverage is meager or nonexistent in many insurance policies.

• Half of indemnity plans and Preferred Provider Organizations (PPOs), 20 percent of Point of Service (POS) networks, and seven percent of Health Maintenance Organizations (HMOs) cover no reversible contraception.

• Even plans that do provide some coverage typically do not cover all of the five most commonly used reversible contraceptive methods (oral contraceptives, the IUD, diaphragm, NorplantÒ and Depo ProveraÒ ). Less than 20 percent of traditional indemnity plans and PPOs and less than 40 percent of POS networks or HMOs routinely allow women to choose among these five contraceptive methods.

• Coverage of prescription drugs in general usually does not even include coverage for oral contraceptives, the most commonly used reversible contraceptive method in the United States. Although 97 percent of typical indemnity policies cover prescription drugs in general, only 33 percent include oral contraceptives in that coverage. This leaves two-thirds of typical indemnity plans covering "prescription drugs" but not the prescription so many women need access to – oral contraceptives.

• Ready access to contraceptive services increases the likelihood that the estimated 12 million Americans contracting sexually transmitted infections each year will be diagnosed and treated.

• As they help women avoid unplanned pregnancies, contraceptive services help make "planned pregnancies" possible. A study of 45,000 women suggests that women who used family planning services in the two years before conception were more likely to receive early and adequate prenatal care.

• The National Commission to Prevent Infant Mortality estimated that 10 percent of infant deaths could be prevented if all pregnancies were planned; in 1989 alone, 4,000 infant lives could have been saved.

Insurers have relied on women and their families paying out of pocket for contraceptive services and supplies, forcing financial decisions that may result in the use of less effective or less medically appropriate contraceptive methods.

• Women of reproductive age currently spend 68 percent more in out-of-pocket health care costs than men. Much of the gender gap in expenses is due to reproductive health-related supplies and services.

• The more effective forms of contraception are generally also the most expensive, often costing hundreds of dollars at the outset of patient use. Women and their families who must pay out of pocket may well opt for less expensive and sometimes less effective methods, thus increasing the number of unintended pregnancies.

• Cost analyses for similar bills at the state level have shown that if health insurance policies were to include coverage for these contraceptive supplies, annual cost increases would be minimal, only $16.00 per enrollee.

The correlation is clear. Contraception prevents unintended pregnancy and reduces the need for abortion.

• In any single year, 85 of 100 sexually active women not using a contraceptive method become pregnant. In contrast, of 100 oral contraceptive users, only between three and six percent become pregnant in a year.

• Because the likelihood of pregnancy is so great if contraception is not used, the 10 percent of American women at risk of unintended pregnancy who do not use contraception account for 53 percent of all unintended pregnancies.

• Reducing unintended pregnancy is key to reducing the number of abortions; almost half of unintended pregnancies end in abortion.

Prepared with the assistance of The Allen Guttmacher Institute 4/97.)

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