Birth control pills
Paula Tran, a senior at the University of Wisconsin-Madison, relies on her school's health center for affordable birth control pills. Even though she doesn't have insurance, she bought a year supply from the clinic for only $7 per pack last fall. But when she goes back for more this September, she'll be hit with a bill five times that amount, something she says will definitely affect her spending. "It will cut into the kinds of notebooks I buy to the kind of groceries I get to the cable package that I order," she says.
For decades college campus health centers have been a resource for budget-conscious female students seeking birth control. Because of agreements with pharmaceutical companies, most campus clinics were able to distribute brand name prescription contraceptives, from pills to the patch to a monthly vaginal device like NuvaRing, for no more than a couple of bucks.
That all ended earlier this year. Health experts say the price bump for college students was inadvertent — a byproduct of the Deficit Reduction Act of 2005, a federal law that went into effect in January. The law alters how drug makers calculate Medicaid-related rebates paid to states, but it ultimately made it expensive for companies to offer schools such deep discounts on birth control. As a result, brand name prescription prices for campus clinics rose from about the $3 to $10 range per month to the $30 to $50 range. Organon, the maker of Cyclessa and Desogen birth control pills and the NuvaRing, says the company is not happy about having to increase prices for colleges. But Nick Hart, Organon's executive director of contraception, says they were forced to make "a business decision" after the law went into effect.
Although the law has been in place for months, students will start paying more now because stockpiles that let most university health centers delay the price increase ran out in the spring. "At the end of the semester we started getting notes on our packages of birth control saying that they were running low and as soon as they ran out of the old stock we could expect to pay $40 a month," says Jessica Faerman, 20, a junior at the University of Texas.
Many schools even had trouble stretching their low-cost birth control supplies through the spring. Jason Walker-Crawford, managing pharmacist at the University of Wisconsin-Madison's health clinic, says he found out about the change in prices when he went to place an order on Jan. 2, the day after the new law went into effect. He discovered that most brand name prescriptions for the clinic went from $8 to $42 per month. Walker-Crawford says the clinic was forced to ration what they had on hand, limiting students to buying only one prescription pack at a time instead of sets of three or more. "We tried to make some time so that everybody had some chance to look into some other options," he says, which include getting students on an insurance plan, either through their parents or through an income-based state family planning waiver program.
So the solution is that insurance will cover the price upsurge, right? Health care providers and experts are saying it's not that simple. The problem is that many students pay for their prescription birth control out-of-pocket because they don't want to involve their parents' insurance for privacy reasons. Others don't want to deal with hassle that comes along with getting and maintaining health insurance, which can require co-payments that are more than what students were originally spending on birth control in the first place.
A 2006 survey conducted by the American College Health Association (ACHA) found that 39% of undergraduate women use oral contraceptives. Many providers are afraid that if the convenience of free or cheap birth control on campus is taken away, female students might just get turned off by prescription birth control methods altogether and use other less effective ones like condoms or Plan B, known as the morning after pill. Even switching to generic medications, most say, while better than nothing, isn't ideal because of the side effects that sometimes come along with them. "We do know that high fees act as a barrier to obtaining care. That is classically understood in campus health services," says Claudia Covello, director at the University of California-Berkeley's health center.
Prescription birth control — which includes the pill, the patch and NuvaRing — is 99.7% effective, according to Planned Parenthood, and many worry if students skip out on it or move to a method they're not as comfortable with, it can lead to more unwanted student pregnancies. "I think there are some who will just try to wing it and see how it goes. They'll say 'Well I go to school here, my boyfriend is in another city and I only see him once or twice a month and I won't use anything' rather than pay for something they can't afford. That's absolutely dangerous," says Dr. Nancy Jasper, an assistant clinical professor at Columbia University's medical school.
While Tran from the University of Wisconsin-Madison says she's going to stick with the health center and work out the pricing in her budget, she knows many students who are opting out. "I have friends who refuse to talk to their parents about it, they're unable to get under their insurance, can't afford to get their own insurance and are already working just to pay tuition," she says. "Some have stopped already and are taking stock in Plan B and having that around because they don't have regular intercourse."
Companies are already seeing an increase in Plan B, although they are unsure if it's connected to the rising price of prescription birth control. Barr Pharmaceuticals reported in July that their Plan B sales have doubled — going from $40 million a year to what will probably be about $80 million in 2007. Walker-Crawford says that at the University of Wisconsin-Madison, he went from selling it mostly on Mondays to having it purchased by students every day. Health officials say they discourage using Plan B as a regular form of contraception because, although there's no physical risk to doing so, students will be missing out on the menstrual cycle regulation and the required annual exams that come along with a regular oral contraceptive prescription.
The health clinic at Bowdoin College in Maine has elected to stop offering birth control to students altogether because of the price increases, says Sandra Hayes, the center's director. Prescription birth contol used to be free of charge, but starting this fall all the clinic will provide patients with is a written prescription and the directions to the nearest CVS or Walgreen's, where they'll have to pay standard price. However, Plan B is still available to students for free and Jessica Walker, a Bowdoin junior and member of the school's women's association, says the group is planning to hold clinics in the student union a few times during the year where women can get birth control pill packs for $10 to $20.
AHCA, a college health advocacy organization, says that since it became aware of the Deficit Reduction Act they have been doing everything they can to fight for an exemption in the law for college health centers. The group's advocacy chair Mary Hoban says that while she's pretty sure the impact on college students was unintentional, their only recourse for the time being is a legislative fix from Congress. "We are contacting members in Congress to make sure they understand what the impact of the Deficit Reduction Act has on their campuses and asking for their help when they see an opportunity to legislate a solution to this," she says. But so far she says she hasn't had much luck.
Likewise, college health clinics are finding that they can do little except refer students to Planned Parenthood, where clinics are working to keep prices low despite some being affected by the law too. Clinics also warn that students could see increases in prices for other prescriptions and products at student health centers since the price jumps are also damaging to clinics' profits. Because the health centers used to receive prescription contraceptives at a nominal, or base price, they could tack on a few dollars to the student price to put back into the clinic in other areas. "This has definitely had an impact on our bottom line to the point where we are going to have to raise our fees to compensate for the loss of revenue," Walker-Crawford from the University of Wisconsin-Madison says. "Which means prices will go up on everything for everybody."