Senators agree on over-the-counter contraception, but not on cost sharing

Senator Patty Murray (D-Wash), Ranking Member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, has introduced a bill that would require insurance companies to provide coverage for any birth control pills that the FDA may approve for over-the-counter (OTC) sales. Murray’s Affordability is Access Act would maintain the FDA’s sole authority to determine the safety and effectiveness of drugs and make them available over-the-counter, as well as prevent retailers from interfering with a customer’s access to any oral contraceptive that the FDA has approved or regulated for routine, daily use. The bill comes on the heels of the Allowing Greater Access to Safe and Effective Contraception Act, introduced by Senators Cory Gardner (R-Colo) and Kelly Ayotte (R-NH), which would provide incentives to manufacturers of oral contraceptives to seek over-the-counter status, but would not require insurance coverage.

Over-the-counter contraception

Emergency oral contraception in the form of Plan B® and Plan B One-Step® is currently available OTC. However, the proposed bills would encourage the OTC delivery of safe and effective birth control pills for routine, daily use. According to Gardner, “Most other drugs with such a long history of safe and routine use are available for purchase over the counter, and contraception should join them.” Although it is unusual for insurance companies to cover OTC medication, it is not unprecedented; some insurance companies, for example, may cover Prilosec®, a heartburn drug, in certain circumstances.

Competing bills

Gardner and Ayotte’s plan would limit OTC accessibility to adults aged 18 or over. It would allow for priority review and waive the FDA filing fee for prescription to OTC applications. It would also repeal the ACA’s prohibition on health savings accounts, but it would not require insurers to cover the medication. Murray’s bill would not impose an age minimum. According to Murray, “affordability and access go hand in hand.” Critics of the Republican bill note that oral contraception can cost $600 a year, making it unaffordable for many. Murray’s bill would build on the Patient Protection and Affordable Care Act’s (ACA’s) (P.L. 111-148) contraception mandate. “Anyone will tell you that if something is too expensive, it doesn’t matter how easy it is to get,” Murray stated. “It might as well be on the moon.”