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Friday, October 13, 2017

Look to Markets, Not the State, for Access to Contraceptives

Women should absolutely have easier and more affordable access to birth control, but it should not come from a state mandate.

The Trump Administration is getting a lot of criticism for its decision to rollback the Obamacare mandate that required employers to include contraceptive coverage in their company premiums. In addition to asking these companies to alter their current plans, it also demanded that oral contraception copays be brought down to zero dollars for insurance holders.

As these types of essential monthly costs can quickly add up, many women were pleased to be relieved of this burdensome expense. And while this has been convenient for many, it doesn’t make the mandate just. It also isn’t the best way to offer affordable birth control to more women.

Private companies are just that: private. They should not have their company guidelines dictated by state interference. Not to mention, altering insurance premiums for an entire company is not only time consuming for human resources, it also costs more money for the employer. These are funds that could have been used elsewhere, possibly even on increasing employee salaries. But this money must be provided for by the private company and not those responsible for crafting the policy.

But what is most important to understand is that this mandate creates obstacles for the market that in turn make birth control perpetually inaccessible to those who may not have access to insurance or who may have made the personal choice to be uncovered.

Asking the government to mandate access to a product is in no way liberating. 

The birth control coverage issue is one that is rarely met with anything but controversy. But as the country argues over whether employer contraception coverage should be mandated by law, the real issue gets ignored: access to birth control should be far easier than it is today and the government is preventing this from happening.

State Control, Not Liberation

Many proponents of the Obamacare birth control mandate assert that it gives women more control over their lives. To be sure, the advent of birth control was extremely empowering to women as it gave them control over family planning and thus, their own futures for the first time in history.

Unfortunately, asking the government to mandate access to a product is in no way liberating. In fact, it is the epitome of control.

There is virtually no logical reason to explain why birth control is so difficult to obtain today.

If I have a minor headache or a muscle ache, I have the ability to go to my local drugstore and choose from a variety of products all aimed at making me feel better.

And while these products are relatively safe, there will always be a risk of consumers misusing or abusing even something as seemingly harmless as Tylenol. Knowing this, it seems odd that something as commonly used as birth control is still only available to women through state intervention.

Thanks to the FDA approval process and state control over prescription drugs, getting birth control is as strenuous as obtaining other medications with much harsher and potentially dangerous side effects.

Currently, women must find a doctor, rearrange their busy schedules to visit the doctor, and then sit through a rather intrusive line of questioning before they are handed a piece of paper that essentially gives them the state’s permission to use contraception.

While the government is taking its precious time, the market has found a way to make birth control more accessible.

This is similar to the process required for patients seeking antidepressant or psychotropic drugs which both come with a plethora of safety precautions and risks. Birth control is not only safer, it already fits the FDA’s own benchmarks for being sold over the counter. Yet, it has been routinely prevented from being sold over the counter.

It should also be highlighted that in countries where oral contraception is available over the counter, there have been no reported increases in negative health-related incidents.

The Over-The-Counter Solution

By allowing oral contraception to be sold over the counter, the corresponding costs would be free from the price distortion that always accompanies third-party insurance companies.

When you go to the store to purchase Advil, you don’t have to wonder about how much you will end up paying out of pocket. The price is listed on or near the product and you know exactly what you will pay when you reach the register. This helps keeps prices low as consumers understand when a product’s price is unnecessarily high, especially when they are able to do a side-by-side comparison to other similar products in the aisle.

When you are given a prescription for birth control from a doctor, you are given access only to that prescription and any generic version of that specific chemical compound. You only know what that one particular product will cost, which puts the consumer at a disadvantage since they cannot compare with other products on the market. A Google search can get you an idea of the general cost, but since this does not factor in individual insurance premiums, it becomes a giant guessing game.

In addition to cost, selling contraception over the counter would make it much easier for women to gain physical access to it. Instead of having to worry about getting to a pharmacy in between work and other responsibilities, women could go to any drug store, at any time and select their brand of choice. This would also help prevent the common issue of missing doses between contraceptive packs because consumers would have easier access that is not based on whether or not they have a prescription.  

The movement to move birth control from a prescription drug to an over the counter drug has been growing over the last decade. However, it is the government and specifically the FDA that is dragging its heels on making this a reality.

In January, it was announced that Ibis Reproductive Health, a nonprofit organization had joined forces with the European company, HRA Pharma to further the efforts to make oral contraception available over the counter. But even though this sentiment is spreading, thanks to lengthy government approval processes, this is unlikely to happen within the United States anytime soon.

So long as demand exists, free enterprise will always find a way. 

But thankfully, while the government is taking its precious time, the market has found a way to make birth control more accessible to more woman at an affordable cost. And they have done so in spite of the government.

Uber for Birth Control

The market is a resilient force. So long as demand exists, free enterprise will always find a way. Since its creation, contraception has been a product for which there is always high demand. But now, the sharing economy model is making it easier for women to bypass the traditional methods of gaining a prescription, without ever having to leave their homes.

There is almost nothing the sharing economy cannot provide for the consumer. From inexpensive rides and cheap short-term lodging alternatives to food delivery and even puppies on demand, this organic market force has become a huge source of convenience in our lives.

Over the last few years, and thanks to the telemedicine laws that allow doctors to visit with patients online, the sharing economy has expanded into the health sector, specifically contraception.

The San Francisco-based startup Nurx has been doing its best to make oral contraceptives more accessible for female consumers. The startup works by providing users with a birth control consultation online. After filling out the relevant health-related questionnaire on the site, consumers can either choose from a list of available brands or let the doctor choose for them based on their medical history.

For those without insurance, Nurx waives the consultation fee and provides its birth control options for just $15 a month. But its services do not end there. After the prescription has been written by a Nurx affiliated doctor, a three-month supply is then delivered to the consumer’s door within a day.

Under the Obamacare mandate, only those with insurance coverage were given the $0 copay for oral contraceptives. For those without insurance, one month of birth control can cost an obscene amount of money even reaching triple digits. But thanks to Nurx, uninsured women have options.

Nurx co-founder and attorney Hans Gangeskar commented:

It’s absolutely ridiculous the way the system works. We absolutely believe oral contraceptives should be available over the counter. This is one step on the way.”

Unfortunately, telemedicine laws vary from state to state, which precludes many from taking part in these market alternatives. But this model is catching on and while it isn’t perfect, it is still a major disrupter when it comes to shaking up the up the way contraceptives are distributed to patients.

The issue of access to birth control is important. But unfortunately, many people can only fathom solutions that fit within the framework of our current state-dominated system, instead of creating new and potentially revolutionary market alternatives. This usually means utilizing government authority to reach a desired end. But as Nurx is demonstrating, there are better options available now. Just imagine how much better these alternatives would be if the state wasn’t involved at all.

Women should absolutely have easier and more affordable access to birth control, but it should not come from a state mandate. The market is more than capable of dealing with the contraception issue and is doing so in a way that supports the female consumer without hurting other individuals or forcing private companies to pay for something against their will.

  • Brittany is a writer for the Pacific Legal Foundation. She is a co-host of “The Way The World Works,” a Tuttle Twins podcast for families.