Emergency Contraception and Medicaid: A State-by-State Analysis and Advocate’s

In June 2004, the American Society for Emergency Contraception, the Compton Foundation, the John Merck Fund and the Open Society Institute co-hosted an Emergency Contraception Funding Strategy Meeting. During the meeting, advocates from across the country discussed the implications of the U.S. Food and Drug Administration?s rejection of the petition to permit Plan B® emergency contraception to be sold over-the-counter. The FDA?s decision was examined under the lens of the three overarching priorities identified in From Secret To Shelf: How Collaboration is Bringing Emergency Contraception to Women1: educating women about emergency contraception; educating clinicians, pharmacists, policymakers and other stakeholders; and, removing barriers to obtaining the pills within 72 hours after unprotected sex. Eleven priorities emerged from the meeting. Yet, one priority was repeatedly mentioned by national and local advocates as central to ensuring that all women, regardless of income, have access to EC: broadening and deepening state-level advocacy on Medicaid reimbursement. 

 

In order to elevate this discussion, a diverse group of advocates, researchers and health care professionals was convened to examine Medicaid reimbursement of EC. The Institute for Reproductive Health Access facilitated the first meeting of the EC & Medicaid Working Group in August 2004. The working group, composed of over 20 local and national reproductive health, policy and advocacy groups, identified two overarching areas that required further research: current coverage of Plan B® within state Medicaid programs and the process to add over-the-counter drugs to state Medicaid drug formularies. 

A smaller research subcommittee was formed by staff of the Institute for Reproductive Health Access, Ibis Reproductive Health, the Massachusetts Department of Health, the National Health Law Program and the National Latina Institute for Reproductive Health to address the issue of how women on Medicaid would be affected by the ?dual-label? product being considered for FDA approval, which would maintain the prescription requirement for those under 15 while allowing direct, non-prescription access to women aged 16 and older. Specifically, the subcommittee wanted to explore current Medicaid coverage of nonprescription products, in order to anticipate how a non-prescription or dual-label emergency contraceptive product might be treated by state Medicaid programs. However, rather than reveal the potential obstacles to coverage of non-prescription Plan B®, this research uncovered significant and persistent gaps in coverage of the prescription product. While it is incumbent upon Barr Laboratories, the company that manufactures Plan B®, to ensure that their product is approved for coverage under each state?s Medicaid program, advocates must also initiate and strengthen efforts to improve access to EC for women on Medicaid. 

As this analysis will demonstrate, universal coverage of prescription EC under state Medicaid programs is within reach. A few states do not cover EC under their Medicaid programs, and in some states, it remains unclear whether Medicaid covers EC. In some states that do cover EC, barriers to access, including complex and unnecessary prior authorization requirements and misinformation about EC provided through client hotlines, persist. Undoubtedly, these barriers significantly impact the ability of a population at high risk for unintended pregnancy to access this important prevention method.