By Brittany Lee
It’s time for New Jersey to update its laws around prescribing and dispensing birth control and give people greater control in deciding when or if they grow their families.
Health care providers should be able to prescribe a full year of contraceptives at one time. A state commission studied the issue and published a report that found that a full year prescription promotes good public health and would save the state millions of dollars. Still, the law has not been changed. Today, under most health plans in New Jersey, if an individual wants to start taking contraception, such as oral contraceptives, or “the pill,” they must go to their doctor to get an initial three-month prescription. After confirming they are not having any negative side effects, they need to get a new prescription from their provider for their insurance to cover the dispensing of six additional months of the medication. After that, and despite how many years a patient is on the same prescription, the patient must continue to get a new prescription from their provider every six months.
The Reproductive Freedom Act (S3030/A4848), which is currently awaiting a hearing in the legislature, would change this outdated policy. In addition to protecting the right to reproductive health care in New Jersey, this legislation would require most health insurers in the state to provide coverage for a full year of birth control in a single prescription. This legislation does not alter any current exemptions held by some religiously affiliated employers, such as churches, regarding the current contraceptive coverage mandate.
Allowing for one year prescribing aligns with guidance from the U.S. Centers for Disease Control and major medical organizations, including the American College of Obstetrics and Gynecology. Research has shown that when individuals are provided with a one-year supply of contraceptives, their risk of unintended pregnancy decreases by 30%. Despite this, New Jersey has been hesitant to align its laws with this evidenced-based best practice. After years of legislation for full year prescribing being introduced and not moving forward, amended legislation passed in 2017 to require insurance coverage for dispensing of six-months of birth control at one time. While this was an improvement, it still falls short of what research tells us is most effective.
During the COVID-19 pandemic, limiting the number of trips an individual needs to take to both their provider’s office and pharmacy helps promote safe social distancing and reduces risks of contracting or spreading the virus. But in general, there are many factors that make it incredibly difficult for a patient to see their provider multiple times in a year, including transportation, child-care, and time off work. These barriers are even more significant for individuals with lower incomes and with limited access to resources. Requiring patients to navigate these obstacles to have an appointment that is not medically necessary increases the likelihood that they will stop using contraceptives or face a gap in use, increasing their risk of an unintended pregnancy.
Over the years, the loudest objections to full-year prescriptions have come from insurers over the potential financial impact of providing extended supplies of medication without guarantee that the patient will continue to be enrolled in their health plan — as well as the risk that they might pay for medications that go unused. However, a May 2019 report issued by the New Jersey Mandated Health Benefits Advisory Commission stated that this change would actually “result in a net cost savings to insurers, employers and consumers in New Jersey.” The report, which was based on 2019 legislation that proposed the same expansion of coverage, estimated $1.2 million to $2.7 million in net savings for the state’s health care market and system in just the first year. The savings would be the result of reduced costs associated with unintended pregnancies and takes into account the potential for waste if an individual stops or changes their contraceptive. These estimates do not include extending this policy to the state’s Medicaid program — which, if included, could result in significantly more savings to the state.
Overall, the hesitancy and history behind making this change is not rooted in specific medical or financial concerns, but rather by stigma around contraceptive use and a general lack of prioritization of reproductive health as essential health care. The CDC includes contraception among the ten greatest public health achievements of the 20th century. Yet, it is near impossible to identify other health care services that are as safe and cost-effective as birth control that face anywhere near the same number of unnecessary obstacles. Reproductive health care, including contraceptive care, should not be hindered by restrictions that are not based in medicine and do not protect patients, especially when it would result in overall net savings for the state.
Currently, 19 states have successfully passed legislation to require coverage of a full year of birth control. It is time that the New Jersey joins them. It’s time for the legislature to both hear the Reproductive Freedom Act and pass this important bill so that meaningful access to reproductive health services, including full year prescribing of contraceptives, is fully achieved for our residents.
Brittany Lee is program officer for the New Jersey Health Care Quality Institute.