Ending the Great Pill Price Hike
Congress, step up for college women before the year ends.
As Congress dashes madly toward Christmas, it should not overlook a sliver of language that would restore low-cost birth-control pills to women on college campuses.
Many women can no longer get discounted contraceptive pills while they're at school, thanks to an earlier congressional screw-up. When legislators passed a law called the Deficit Reduction Act in 2005, they apparently forgot to include college and university health centers on a list of providers eligible for special discounts from pharmaceutical companies. (Whoops.) As a result, after the law took effect in January, the price of brand-name birth-control pills has quadrupled, or more, on many campuses. At some schools, fewer students are now filling prescriptions for the pill, while more are coming in for emergency contraception and pregnancy tests, according to the American College Health Association.
The problem should be easy to fix: Congress could simply add college and university health centers to the list of discount-eligible providers by attaching this language to any number of bills. This would cost taxpayers exactly nothing. Some lawmakers, like Rep. Joseph Crowley, D-N,Y., Sen. Claire McCaskill, D-Mo., and Sen. Barack Obama, D-Ill., are pushing to make that happen. The matter is pressing, especially since the government has now blown $1 billion on programs that promote abstinence until marriage and typically badmouth contraception, all without any known benefit. Maybe it's no coincidence that the U.S. teen birth rate just rose for the first time in 14 years, according to the Centers for Disease Control and Prevention. Whatever the case, it's no time to monkey with birth-control access for college students.
For years, college women got a great deal on the pill, paying anywhere from pennies to a few dollars for a month's supply. That arrangement stemmed from a 1990 law, which allowed pharmaceutical companies to give deep discounts to college and university health centers and other safety-net providers without affecting the so-called "best price" they are required to give Medicaid. The deal helped drug companies, too, by building brand loyalty among young women who would likely someday have private health insurance. Over time, though, lawmakers began to fret that drug companies were giving the discounts too loosely as promotions, shortchanging Medicaid in the process. So, in 2005, they came up with a list of providers to rein in the deals. Federally funded family-planning clinics made the cut, luckily. But colleges and universities didn't—in what lawmakers now say was an oversight.
That snafu has taken a fiendishly long time to correct. Early this year, health-care advocates petitioned the Department of Health and Human Services to add colleges and universities to the discount-eligible list. In July, HHS said the list was just fine the way it was. In March, Democratic Reps. Joseph Crowley and Tim Ryan tried to add the fix to a supplemental war-spending bill. But other lawmakers reportedly cringed at mixing birth control with the troops. In November, Crowley and Ryan, along with Democratic Rep. Adam Schiff and Republican Reps. Jim Ramstad and Mark Kirk, introduced a stand-alone bill; and Sens. Obama and McCaskill did the same in the Senate. But despite some bipartisan support, these measures haven't gotten very far. Behind the scenes, conservatives have insinuated that the correction would cost the government money and be a boondoggle for abortion-lovers. "When they tried to slip this in a bill earlier this year, we called it the 'Planned Parenthood discount drug earmark,' " a Republican aide reportedly said. "It will be even less popular now." (Seventy-five percent of Planned Parenthood clinics are actually still eligible for the discounts.)
Meanwhile, some campus health centers stockpiled discounted pills before the new law took effect. But others did not. And either way, by now many have run out and had to pass the new hefty bills on to students. Pills that used to cost from $3 to $10 per month can now go for $30 to $50 per month or more. Even generics can cost several-fold more than the previous price for brand-name products. And some schools have stopped offering birth-control pills entirely, according to the ACHA.
The impact on students can't be good. Some women can still get affordable birth control through their parents' health plans or by finding a nearby public clinic that still offers discounts. But some would rather their parents not know they're on the pill. And many will have trouble getting to public clinics, especially in rural areas. The bottom line is that of the three million college women who rely on oral contraception, some no longer have reliable access. And some will inevitably get pregnant as a result. Women this age appear particularly vulnerable: In 2005-06, the birth rate for 18- and 19-year-olds was three times higher than that for 15- to 17-year-olds.
With its useless and medically inaccurate abstinence programs, the federal government already shortchanges high-school students when it comes to contraception. Now it's adding to the burdens of college women, who need more access to the pill, not less. It's up to Congress to get it together this week and make it easier for college students to protect themselves. The necessary language would fit on a Post-It note. Let's just hope it sticks to something—anything—that makes it into law this year.
Amanda Schaffer is a science and medical columnist for Slate.
Photograph of birth control pills by Stockbyte.