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

Executive Summary

This report provides state-by-state analysis and advocacy tools and tips around emergency contraception access in Medicaid.

Overview
The Institute for Reproductive Health Access, the National Health Law Program, the National Latina Institute for Reproductive Health Access and Ibis Reproductive Health are pleased to present to the reproductive health advocacy community: Emergency Contraception & Medicaid: A State-by-State Analysis and Advocate?s Toolkit. This toolkit has two purposes. The first is to provide an overview of the range of issues that women on Medicaid currently face in accessing emergency contraception (EC). The second purpose is to identify specific steps that advocates can take at the local level to address barriers that may exist in their state and to lay the groundwork for eventual Medicaid coverage of nonprescription EC. By working together at the state and federal level, we have the potential to greatly increase access to EC for many low-income women. 
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. 

The potential switch from prescription to non-prescription or ?dual-label? status will clearly present new challenges. Many Medicaid programs are not designed to handle ?dual-label? products, or even over-the-counter medications. If women on Medicaid are forced to obtain prescriptions for EC even after it becomes available over-the-counter, as our brief analysis on the topic indicates, they will be effectively excluded from the benefits of a nonprescription product. 
Emergency Contraception & Medicaid: A State-by-State Analysis and Advocate?s Toolkit provides a general overview of prescription drug coverage under Medicaid, specific barriers to EC access, and a look at Medicaid coverage of EC in the 50 states and the District of Columbia as of September 2005. The last section offers steps advocates can take to ensure universal Medicaid coverage of EC, remove barriers where they exist and begin a dialogue to ensure eventual coverage of non-prescription EC.
 

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