FPA in the News: 2007

Legislative Gazette
Plan B access expanded for Medicaid
By: Ariana Cohn
1.29.07

Starting on Feb. 1, Medicaid patients will no longer need a fiscal order from a doctor to receive coverage for Plan B emergency contraception.

Women’s advocacy groups, including Planned Parenthood and Family Planning Advocates of New York State, praised Gov. Eliot Spitzer last week for expanding access to emergency contraception aimed at preventing unintended pregnancy.

And some lawmakers are gearing up to once again introduce legislation that would make Plan B available without a prescription to women of all ages.

A letter from Deborah Bachrach, Medicaid director and deputy commissioner of the Office of Health Insurance Programs, was recently distributed pharmacists statewide announcing that Medicaid recipients will no longer need a fiscal order to obtain the drug. Fiscal orders are like prescriptions but are typically written for over-the-counter medications that do not require a prescription.

The letter also outlines steps pharmacists should follow to receive Medicaid payment for the drug.

Women younger than 18 will still be required to obtain a prescription to receive EC, according to Bachrach’s letter, and “Plan B will be will be limited to six courses of therapy in any 12-month period for any Plan B prescription and non-prescription combination.”

Since Aug. 24, the U.S. Food and Drug Administration has allowed emergency contraception, also known as the “EC pill,” “morning after pill” or “Plan B,” to be sold to women 18 and older without a prescription, as long as they had proof of identification. This decision did not, however, include New York Medicaid recipients, who were still required to obtain fiscal notes for their purchases to be covered.

EC is a hormonal pill that can be taken up to five days after unprotected intercourse, though it is considered more effective if taken within 72 hours after sex.

It can reduce a woman’s chance of getting pregnant by up to 94 percent, according to information found on a Planned Parenthood Web site.

EC works by stopping ovulation and fertilization before pregnancy occurs, however it will not terminate a pregnancy once it is already in progress. Prices for the contraception range from $30 to $100.

“This is a brilliant move by the state Health Department and governor’s office,” said JoAnn Smith, president and CEO of Family Planning Advocates of New York State. “A woman over the age of 18 can get EC at the drugstore without any additional paperwork. Her Medicaid card serves as the only thing she needs,” she said.

When asked about the negative aspects of expanding the availability of EC, Assemblyman Sam Hoyt, D-Buffalo, a member of the Women’s Issues Taskforce, said, “I don’t know that there are cons. To all New Yorkers, it is long overdue.”

Medicaid rules for the coverage of over-the-counter EC were first established by the state Health Department under former Gov. George E. Pataki’s administration.

Attempts by the state lawmakers to expand over-the-counter availability of EC to more New Yorkers, including women younger than 18, have been blocked. Even after the proposal won support in both the Democratic-controlled Assembly and Republican-controlled Senate in 1005, Pataki vetoed the measure.

In his 2005 veto message, Pataki said “the bill would theoretically allow a single doctor anywhere in the state to prescribe emergency contraception for all 19 million New Yorkers.” He was also concerned that the bill did not restrict quantities of the drug that can be purchased at one time, as well as purchase restriction not being limited to females. “I am concerned young men may purchase emergency contraception in an effort to persuade vulnerable young women to engage in unprotected intercourse,” said Pataki.

Perhaps the former governor’s biggest complaint with the bill was that it allowed distribution to women of all ages.

The bill was re-introduced in 2006, but while it passed in the Assembly, it never made it through the Senate. “We amended the bill to address all of [Pataki’s] concerns, but we were unwilling to compromise on full access to all women,” said Assemblywoman Amy Paulin, D-Scarsdale, who sponsored the bill.

Pataki’s decision in 2005 mirrored that of the FDA, as well as the Bush administration, although advocates for women’s rights and many state legislators disagree with the age restriction.

Assemblyman Richard Gottfried, D-Manhattan, who chairs the Assembly’s health committee, said he plans to work with Paulin this year on once again introducing a bill that would enable women of all ages to obtain EC.

“The Bush administration is utterly wrongheaded. Hopefully we’ll be able to get around that decision in New York,” Gottfried said.

“We are putting in a bill that would, in effect, permit young people to gain access,” said Paulin. “We have also added two additional components: one, we want to create a public health campaign to alert women of availability, and two we want to require health companies to pay for emergency contraception.” In addition to Medicaid, the bill would require coverage by private health insurance.

While EC is available to women younger than 18, the process of having to obtain a prescription can create problems for a medication which has proven to be less effective the longer a woman waits to use it.

Traci Perry, vice president for public affairs for Planned Parenthood of New York City, said, “17 year-olds and 16-year-olds still need a prescription.” She said, “There’s no real medical reason why they set it at 18.”

“The keyword here is emergency,” said Assemblywoman Aileen Gunther, D-Forestburgh, who chairs the women’s health subcommittee. “God forbid there was a sexual assault — this can prevent pregnancy. I think that this is the right thing to do,” she said.

Gunther related use of the EC pill to the decrease in the number of abortions in New York. The availability of EC means less unwanted pregnancies, she said, and therefore less abortions.

In addition to lowering the number of unwanted pregnancies, supporters say expanding access to EC for all women could also save the state millions of dollars. Assemblywoman Barbara Lifton, D-Ithaca, chair of the Taskforce for Women’s Issues, estimated that it would save New York $262 million in medical costs.

Lifton also pointed to an American College of Obstetricians and Gynecologists report that estimated the EC pill would cut the abortion rate in half. “It’s good public policy, good state policy — good for women, and good for state government,” she said.

While some have argued increased availability and awareness of EC will promote young women to engage in more unprotected sex, Gottfried said, “there have been extensive studies on the effective easy access to emergency contraception, and it has been very clearly demonstrated it does not result in increased sexual activity or increased unprotected sex.”

“There is absolutely nothing in any of the literature that says that women change their health practices because of the availability of [EC],” said Smith, “This is a major piece in the fight to prevent unintended pregnancies and ensure women are pregnant when they want to be.”