Is it time to patch up insurers’ inconsistent birth control coverage?

Many Canadian insurers are not including contraceptive and birth control devices in their coverage – which may pose a problem

by Leo Almazora

The Affordable Care Act in the US mandates that insurance plans in the healthcare marketplace include coverage for birth control, but there’s no such legislation imposed on Canadian insurers. This has led to inconsistent inclusion of contraception among Canadian health insurance plans, says a report in the Canadian Medical Association Journal.

Most provincial health insurance plans provide for costs of drugs and devices only for certain at-risk groups, such as the poor, elderly, or those living in health care facilities. Most Canadians, therefore, rely on supplemental insurance from employers to cover drug-related expenses – a universe that may or may not include contraceptive devices and medications.

According to Joan Weir, director of health and dental policy at the Canadian Life and Health Insurance Association, employers and their insurers have sole discretion on whether or not to include coverage for birth control costs in their policies. Group plans vary widely: some are fairly comprehensive, while others appear to exclude birth control altogether.

The only commitment most employers make is to provide items that are “medically necessary for the treatment of sickness or injury”, which does not apply to contraceptives. Birth control treatments – occasionally called “preventives” – are largely lumped together with elective vaccines and other non-critical items.
However, physicians who are familiar with possible negative effects of pregnancy disagree with current practices.
“It seems quite shocking to me,” said Dr. Monica Kidd, who had a patient request that she lie so her insurance provider would accept her getting the contraceptive pill as a medical cost. “Pregnancy is a risk for some people.”
Dr. Wendy Norman, a physician specializing in family planning at the University of British Columbia, has a long list of complaints. “Insurers are taking a very narrow scope,” she says. The International Federation of Gynecology and Obstetrics has said that about 48% of pregnancies in North America are unwanted. Norman also cites numerous studies by the Guttmacher Institute and others that find women with unplanned children are less likely to finish their schooling and advance in their careers.
She also sees little sense in policies that cover the birth control pill, which has a real-world failure rate of 9%, but exclude IUDs, which have only a 1% failure rate. “It’s phenomenal that insurance plans cover these mid-effective methods but not highly effective methods,” she says.
“Maybe it’s time to revisit this,” says Weir, although she observes that the issue of lack of birth control coverage is not being raised urgently. “People need to make those wishes known.”
The World Health Organization identifies pregnancy as the second-biggest cause of death among reproductive-age women, leading to 300,000 fatalities each year.

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