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Institute of Medicine Calls for Less Expensive Contraceptives for Insured Women
By Matt McMillen
WebMD Health News
Reviewed by Laura J. Martin, MD
July 20, 2011 -- The Institute of Medicine (IOM) has released a report recommending that all FDA-approved forms of birth control be offered to insured women without the burden of additional co-payments.
The recommendation is one of eight made by an IOM panel in its report on clinical preventive services for women.
The report was commissioned by the Department of Health and Human Services (HHS) to identify gaps in women's preventive care currently covered under the 2010 Patient Protection and Affordable Care Act. The panel members expect a quick response to the report.
"HHS will identify which if any of these recommendations they plan to follow by Aug. 1," panel chair Linda Rosenstock, MD, MPH, dean of UCLA's School of Public Health, told reporters in a news briefing.
According to the report, 49% of all pregnancies in 2001 were unintended; 42% of those unintended pregnancies ended in abortion. Unintended pregnancies, the report states, have been linked to lower levels of prenatal care, an increased risk of depression for mothers, and an increased risk for premature births and babies with low birth weights.
Federal health policies and most private insurers already cover contraception and family planning, according to the report, but if the panel's recommendation is accepted, that coverage will be available without co-payments. "The elimination of cost sharing for contraception," the report states, "therefore could greatly increase its use, including use of the more effective and longer-acting methods, especially among poor and low-income women most at risk for unintended pregnancy."
RU-486, otherwise known as the abortion pill, is not covered by the panel's recommendation, panel member Alina Salganicoff, PhD, vice president and director of Women's Health Policy at the Henry J. Kaiser Family Foundation, told reporters.
Planned Parenthood supports the IOM position on contraception. "The IOM recommendation confirms that prescription birth control, along with other key health care services, such as annual exams and HIV screening and counseling, are critical preventive services that improve the health of communities across the country," Vanessa Cullins, MD, vice president for medical affairs at Planned Parenthood Federation of America, says in a news release. "These services need to be accessible for women."
Cardinal Daniel DiNardo, chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, opposes the recommendations. "Without sufficient legal protection for rights of conscience," DiNardo says in a news release, "such a mandate would force all men, women and children to carry health coverage that violates the deeply-held moral and religious convictions of many."
In the briefing for reporters, IOM panel members stressed that the decision to use the recommended preventive services will be up to the patient and her doctor.
Recommended Changes in Health Coverage
In addition to contraceptive devices and counseling, the panel recommends that the following also be covered without co-pay:
- Screenings for gestational diabetes, or diabetes that begins during pregnancy, between weeks 24 and 28 or at the first prenatal visit for pregnant women at high risk of developing diabetes.
- DNA testing for the human papillomavirus, which can cause cervical cancer, in addition to conventional testing, every three years for all women beginning at age 30.
- Yearly counseling on sexually transmitted infections for all sexually active women.
- Yearly HIV counseling and screening for all sexually active women.
- Support for breastfeeding, including counseling and rental costs of breastfeeding equipment. "This is for all women in a situation where they are separated from their child, such as those who have to return to work after six weeks," Rosenstock says.
- Domestic abuse screening and counseling.
- At least one annual well-woman checkup to obtain the recommended tests, screenings, and other preventive services, including preconception and prenatal care.
The IOM report also provides guidance on ways to keep the preventive services covered by the 2010 law up to date and in line with emerging scientific knowledge and evidence-based standards.
One of the sixteen panelists, University of Illinois public health professor Anthony Lo Sasso, PhD, dissented. He says the panel wasn't given enough time to make an informed decision and that the cost of their recommendations be taken into account.
But the committee was not asked to take cost into consideration, and the panel members who spoke to reporters would not speculate on the price that would be required should their recommendations be accepted. However, Rosenstock says, "If you are successful at prevention, then it is a very cost-effective tool."