Today my insurance company denied coverage of one of my prescriptions. Can you guess what prescription that was?
The birth control pill.
Yep. That’s right. I was told today that my insurance would only cover the prescription my doctor gave me for a 28-day supply of the pill once a year.
Let’s unpack that, shall we?
1. The Facts
Before I go absolutely ballistic, I think I should try to be “fair,” for just one minute. The insurance company is willing to cover my birth control pill. It’s just that it will only let me pick up that 28-day supply once a year at a local pharmacy. If I want the pill any other time of year, all I have to do is ask my doctor to prescribe it as a three-month supply and then send that prescription to my insurance company’s mail order pharmacy.
So, from their perspective, they aren’t denying me the drug at all. They’re just telling me that they’ll only cover it if I use their super slow mail order system.
But here’s the thing: I don’t need a three-month supply. My doctor prescribed one month with two refills because the point of the pill for me isn’t to prevent pregnancy. It’s to stabilize my cycle for two weeks before I try yet another round of in vitro fertilization (IVF). (A whole other ball of wax.) I don’t need 84 pills. I need 14.
Also, I need the prescription right away. Because I have to start taking it on day 2 of my period, and that should be starting any day. I don’t have time to wait for this drug to be processed and shipped through a mail order system. Even if I went through the process of having the prescription rewritten and redirected to the mail order system, then forked over the extra $30 or whatever it would cost to expedite a prescription that’s lighter than a flipflop, I wouldn’t know for sure that I would get it on time.
So you know what I had to do today to get my prescription for my birth control pills filled? I had to look up a coupon (bless you, GoodRx), waste time explaining everything to the Walgreens pharmacist, and then pay $20 out of pocket for a single pack of generic birth control pills.
Let’s review those facts, shall we?
- I need about 14 birth control pills.
- I need them this week, possibly within 2 days.
- My insurance provider won’t cover my pills unless I order 84 pills at once via their mail order system and wait for them to be shipped to me.
2. Other than the obvious, why is this a major problem?
I kind of think that most people reading this are likely to be feminists themselves, and women. If you fall into either or both of those categories, then you probably see immediately all kinds of problems with my situation today. To name a few of the obvious problems, here’s what I see:
First, my insurance company will only cover my prescription if I order six times as many pills as I need. My price will go up, I’ll get drugs I don’t need, and I will be part of America’s major over-prescription problem, presumably so that the insurance company can save some money.
Second, as a result of this debacle, I had to pay out of pocket for a cheap, generic drug that should be considered a fundamental aspect of my health care.
Third, the reason my pills are restricted like this is that my insurance company can’t imagine any reason a woman would need to take birth control pills other than to prevent pregnancy. Which, duh, is something you do for more than one month! So the insurance company is assuming that this is a long-term use drug. They have decided for my doctor how many pills I need and for how long I should take them, and if I don’t need the pill as expected, then my use of them isn’t covered.
Fourth, the fact that the insurance company thinks the pill is only used to prevent pregnancy is indicative of a major myth about the pill and one of the reasons the pill is so hard to get to begin with.
3. News Flash: Birth Control Pills Aren’t Just for Birth Control
One of the things that drives me the craziest about this is that birth control pills really aren’t birth control pills for lots of women. They’re reproductive health pills.
The insurance company is basically acting like I’m using birth control pills right now for some nefarious, off-label use that they don’t want to cover, but that’s simply wrong. I’m not using the pills to get high or something. I’m using them to treat serious medical conditions I’m affected by.
I, like many many other women, have mostly NOT taken birth control to prevent pregnancy. I’ve taken it because I have irregular (and mostly non-existent) periods. The pill has protected me from uterine cancer and symptoms of PCOS, such as unwanted facial hair and adult acne. It will, in the future, prevent my adenomyosis from making my uterus swell inside me like a balloon. And right this second, it’s regulating my hormones so that I can start another IVF cycle at “baseline” (which means low estrogen).
In fact, there have never been years when I took birth control pills and expected it to be the tool I used to prevent pregnancy. Even when I was sexually active with partners I did not want to have children with, I never quite trusted the pill with birth control. (I don’t know why. I suppose I just don’t trust my body to do things it’s supposed to do. Maybe that’s crazy. Or maybe that’s what happens to a woman who doesn’t get periods.) So I basically always used condoms. That’s just how it was.
For me, the pill has always been about (a) preventing my reproductive system from killing me; (b) preventing my reproductive system from putting me in worlds of pain; and (c) taming my reproductive system so that I can have kids. Those are “don’t kill me” pills, “don’t hurt me” pills, and pregnancy pills.
But, because the world thinks about the pill as primarily a method of birth control, there’s an even deeper issue here. Which is:
4. The birth control pill is restricted not because it is dangerous, but because it is immoral.
I mean, seriously, folks. Do you know any woman who sells her birth control pills? Takes more than one a day because it gives her some kind of buzz? Has ever tried to push birth control pills at a party?
No. Of course, you don’t. But I bet you know many women who’ve had trouble getting their birth control pill prescription filled for one reason or another. Maybe it was because, like me, the woman’s insurance company decided she HAD to order 84 pills at a time via mail order shipping. Or maybe it was because the type of birth control pill the woman was being prescribed–though important to her health–was considered a luxury item. Like how it’s way more expensive to get the pills that are set up to be taken continuously (I also speak from experience having had this problem). As if somehow we should be taxed for not wanting periods, or for having endometrial conditions that make estrogen bad for us.
Or here’s something that might have happened: maybe you know someone who was using the birth control pill not to get pregnant, but her ob/gyn would only prescribe six months of birth control at a time, then require another appointment. So the doctor would hold those birth control pills hostage until that woman saw the doctor. (This has happened to me multiple times.) As if the birth control pill needs to be so extremely regulated that we should see our doctors every six months just to make sure it’s still okay that we’re on it.
These things are ridiculous. You know what’s not hard to get? Medication for erectile dysfunction. You can bet that if you’re a man and you need something to help you “get it up,” that pill will be accessible to you in all kinds of ways. You’ll be able to fill the prescription wherever and whenever you want.
After all, we highly value the ability of a man to ejaculate freely. But the ability of a woman to protect her body and her reproductive health? Well, now, let’s not get crazy giving women all that choice. Good grief. If you give her the ability to choose birth control, she might go and start choosing to have abortions left and right.
People, the birth control pill should be an over-the-counter product. There’s just no good reason for it not to be. I shouldn’t have to fight with any insurance company for this pill. I should be able to stroll down the “birth control” aisle at my drug store and pick up the “low estrogen bc pill, 14 day supply” for $3.99. Just like I can pick up cold, sinus, allergy, pain, and stomach medicine.
5. But this is just another cost of being a woman, isn’t it?
Now that I’ve spewed ink all over the page with my rage, I feel I can go back to my calm, rational self. The self who knows that this one little problem–the $20 I had to pay to get that birth control pill prescription today–is hardly something worth this many words. Hell, this is just a cost of being a woman. Like getting taxed on tampons. And generally being stuck in the gap part of the gender data gap (a great book came out this year about this, called Invisible Women: Data Bias in a World Designed for Men, by Caroline Criado Perez; you should read it or listen to it).
Truly, though, my fury about the birth control pill is really covering an even worse harm I faced as a woman this week. Because all those reasons that I have to take the birth control pill–PCOS, adenomyosis, infertility–those are all things that haven’t been researched nearly as well as other medical issues. The birth control pill gets used as a catch-all to treat stuff like that, not because it is necessarily the best treatment, but because we’re so behind on research into women’s reproductive health that it’s often all a doctor knows how to do. What that means is that doctors don’t know how to cure things like PCOS, adenomyosis, and infertility. So even though those things affect one of the most basic parts of human existence–my ability to reproduce–I just have to live with them and hope that birth control pills can help me manage symptoms.
So what I’m really furious about this week is that after another negative pregnancy test, my doctor said, “I’m sorry. We’ve done everything. There isn’t anything else for you to try except to attempt another IVF cycle,” and I had to say, “It’s okay.” And it wasn’t that he said I’m sorry that made me angry. I wasn’t even angry at him. I was beyond-words angry at the fact that my doctor is helpless to help me. I was thinking, “So what you’re telling me is that the medical field doesn’t know what’s wrong with me? Because of that, I may never have children? Our best choice here is just to try the same thing we’ve done again?”
None of this is okay. And here’s the worst of the worst: there’s nothing I can do to fix any of this for you or me. Not right this second. Not in a political climate that supports heartbeat bills.
There IS something we can do to try to change the future.
What should you do to make sure your birth control pills are covered by your insurance?
Vote. Ladies, we need a female president, and we need female representation in congress. Find out more about Kamala Harris (my favorite dem candidate) or Elizabeth Warren (not so much my favorite dem candidate, but still a dem and still female) and support one of them. Get behind someone who knows what it’s like to have ovaries. Learn more about The Squad and speak up on their behalf. Support Nancy Pelosi while you’re at it. Until more women are in power, we are powerless to change these things because we don’t have a voice.
Your enraged, feminist friend,
Weslie