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Should birth control be free? - (2/16/2021)

By Dr. Ron Gasbarro

Marie stopped by the pharmacist to pick up prescriptions for herself and her husband. "This burns me up," she said as she handed the pharmacist her credit card. "My husband's Viagra has a zero co-pay. My insurance wants $15 for my birth control pills. So unfair!"

The pharmacist has heard this complaint in the past: "Women should be treated the same as men!" "This is pure sexism!" While the pharmacist believes the genders are equal, the insurance companies look at the issue from a different perspective. Erectile dysfunction, or ED – the reason why phosphodiesterase-5 (PDE-5) inhibitors like sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®) are prescribed – is a pathologic condition that most men prefer to be corrected. Specifically, ED is a disease, which the dictionary defines as "a disorder of structure or function, especially one that produces specific symptoms and is not a direct result of physical injury."

Conversely, contraception is "the deliberate use of artificial methods to prevent pregnancy as a consequence of sexual intercourse." That is, birth control blocks the female's egg from being fertilized. One could even call it a lifestyle enhancer, aka family planning. Indeed, these hormone regulators are used for conditions that have nothing to do with pregnancy. They can make painful endometriosis bearable. They can forestall anemia. They can prevent cancer. Says the American Cancer Society, taking "the pill" for at least five years will reduce the risk of ovarian cancer by 50%. Hence, these agents become medically necessary, and insurance will likely pay for them for the reasons mentioned above. But to limit the number of children a woman has? Maybe not.

When won't insurance companies foot the bill for fertility control? The reasons depend on which way the political winds are blowing. During the George W. Bush era, the fight was on to allow employers who cite a religious or moral objection to opt-out of covering contraception. Then, in 2010, the Affordable Care Act, signed by President Obama, mandated that all health insurance plans were required to cover birth control. By 2020, the US Supreme Court, in a 7-2 ruling, upheld the Führer-in-chief's dream of squelching reproductive rights, which would imperil access to no-cost contraceptives for thousands of women. In 2021, with the stroke of a pen, President Joe Biden reversed the previous administration's policies on reproductive health issues. Just like that!

In the pharmacist's opinion, every couple should have the prerogative of deciding how large they want their family to be, based on their economic and occupational goals. However, should insurance companies be forced to pay for birth control instead of the woman who wants it? Nothing is free. If the woman does not pay for her own birth control, then someone else will have to pay for it – someone who is morally opposed to it. And that is the conundrum.

Birth control should not be a political issue. Yet, like abortion, it is. Contraception is the best way to prevent abortions, which have plummeted dramatically since oral contraception was introduced in the 1970s. The obvious form of contraception – abstinence – is free. Getting pregnant involves a male as well [Biology 101]. If the male will not use a condom, and the female will not shell out a few bucks for birth control, then education is lacking. There is outercourse (the opposite of intercourse - figure it out!) and fertility awareness. Check out Planned Parenthood and other programs for contraception options. The pharmacist suggested to Marie that she call her insurance company to find out when she can benefit from 2021's more progressive plan.

Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press.

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