Yet another barrier to pregnancy prevention

_
_ Posts: 6,657
edited January 2010 in A Moving Train
I'm so pissed!! :evil: Here's the story:

A co-worker of mine has been on the pill for 15 years. Recently, our employer (the 2nd-largest employer in the state) switched prescription insurance plans, requiring that we get new (hard copy) prescriptions and send in a bunch of paperwork to continue our prescriptions. It took awhile for my co-worker to get in with her doctor for a new prescription and she's been exceptionally busy lately so has fallen behind on getting the paperwork sent off. Also, we only get paid once a month and many of us run out of money at the end of the month. We've all been REALLY broke with the holidays. So she couldn't really afford to set up the new prescription plan just yet (we now have to pay for 3 months at a time). Given that she's single and hasn't had sex in nearly 2 years, she figured a month laps in her coverage shouldn't matter. Besides, if by some miracle she did get laid, there are always condoms and even emergency contraception. What are the chances?

Enter Some Miracle. So last night she hears from an old boyfriend who had moved away and was back in town. He comes over, they have sex. Of course she insisted (over his protests) that they use a condom. So they used a condom AND he pulled out. But she's fearful that he didn't put the condom on in a timely manner. And she noticed right after he pulled out that he didn't have it on. Did he take it off when he pulled out or sometime sooner? She doesn't know.

Being well-educated about reproductive health, she wants to be really responsible. She goes this morning to the pharmacy for emergency contraception (AKA Plan B or the morning after pill). She knows it's available without a prescription. But the pharmacist says it's $50 without a prescription. This month is tight, money-wise. We actually got paid right before Christmas & the paycheck has to last us until the end of January - nearly 6 weeks. She still has $50 in the bank, but not all her bills have cleared yet. She really can't afford it.

No problem. She works here in the clinic & has a friend (me) who can get a prescription called in for her right away. So that's what we do and it should be all good, right? Wrong. Apparently this new prescription plan - which is also MY prescription plan and the plan for most state employees - doesn't cover emergency contraception!! :evil:

What the fuck??? How can it not cover emergency contraception??? Presumably it's because it's available without a prescription. But that's irrelevant if people can't afford it without a prescription!! $50 is a lot of money! I bet they cover other pills, with prescriptions, that are also available without them. She wouldn't have had a lapse in her birth control coverage anyway if her plan hadn't been changed!

I'm not saying there's nothing this woman could have done to avoid being in this situation; obviously she could have not had sex. But I am saying that she acted reasonably and the system is just total bullshit! :evil: And we wonder how responsible women get pregnant in this world. :roll:
Post edited by Unknown User on
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Comments

  • waverider19
    waverider19 Posts: 1
    So you're saying those of us who waited until marriage to stop using condoms and have children are the irresponsible ones?
    Most smaller,non-chain type pharmacies will set up a tab for you and put you on a monthly billing cycle.
  • _
    _ Posts: 6,657
    waverider19 wrote:
    So you're saying those of us who waited until marriage to stop using condoms and have children are the irresponsible ones?

    I have no idea what this means.
    waverider19 wrote:
    Most smaller,non-chain type pharmacies will set up a tab for you and put you on a monthly billing cycle.

    I have never heard of any pharmacies in town that will do this, and since I run our EC hotline I generally keep up on these things.
  • _
    _ Posts: 6,657
    Here's another thing to consider: We tell patients that they should get this pill in advance so they'll have it readily available if they ever need it. Who the hell is going to pay $50 to have something around just in case? It's just completely unrealistic.
  • cincybearcat
    cincybearcat Posts: 16,830
    scb wrote:
    Here's another thing to consider: We tell patients that they should get this pill in advance so they'll have it readily available if they ever need it. Who the hell is going to pay $50 to have something around just in case? It's just completely unrealistic.


    Well $50 vs paying for a child? Big difference.

    Anyhow, plenty of personal responsibility (her and him) on this one, but it should be far easier for people to get the prescriptions that they have in a timely manner and without all the paperwork hassle for sure.
    hippiemom = goodness
  • LloydXmas
    LloydXmas Posts: 7,539
    The Plan B pill is over the counter so why should it be covered by the insurance companies?
    Clariton is over the counter and you can't get reimbursed for that.

    It's easy to blame the insurance companies but usually with scripts it has to do with the drug manufacturer. Prices for prescriptions do vary by location and company. The same drug at A walmart may cost less than at a CVS
  • redrock
    redrock Posts: 18,341
    Oral contraception is free in the UK. It helps!
  • _
    _ Posts: 6,657
    cincybearcat wrote:
    scb wrote:
    Here's another thing to consider: We tell patients that they should get this pill in advance so they'll have it readily available if they ever need it. Who the hell is going to pay $50 to have something around just in case? It's just completely unrealistic.


    Well $50 vs paying for a child? Big difference.

    Except that it's not $50 vs paying for a child. It's $50 vs a very small chance that you'll get pregnant. If there were $100 odds that you'd get pregnant, that would be different.
  • _
    _ Posts: 6,657
    BabaBooey1979 wrote:
    The Plan B pill is over the counter so why should it be covered by the insurance companies?
    Clariton is over the counter and you can't get reimbursed for that.

    It's easy to blame the insurance companies but usually with scripts it has to do with the drug manufacturer. Prices for prescriptions do vary by location and company. The same drug at A walmart may cost less than at a CVS

    I think there are plenty of drugs that insurance will pay for that are also available over without a prescription. 800 mg Iburophen, for example. And I know there are allergy meds, stomach meds, etc. as well.
  • _
    _ Posts: 6,657
    redrock wrote:
    Oral contraception is free in the UK. It helps!

    And the UK has a lower rate of unintended pregnancy than the US. Coincidence? I don't think so.
  • redrock
    redrock Posts: 18,341
    scb wrote:
    redrock wrote:
    Oral contraception is free in the UK. It helps!

    And the UK has a lower rate of unintended pregnancy than the US. Coincidence? I don't think so.

    Though it still has the highest rate of teenage pregnancy in Europe.... Education WITH free contraception... that would be even better!
  • _
    _ Posts: 6,657
    redrock wrote:
    scb wrote:
    redrock wrote:
    Oral contraception is free in the UK. It helps!

    And the UK has a lower rate of unintended pregnancy than the US. Coincidence? I don't think so.

    Though it still has the highest rate of teenage pregnancy in Europe.... Education WITH free contraception... that would be even better!

    Yes, education too would be ideal. Do the other countries in Europe have both free contraception & education?

    I wonder what the UK teen pregnancy rate is compared with the US.
  • inmytree
    inmytree Posts: 4,741
    Call me callous, but the main barrier in this story is your friend's poor planning and her choice to have unprotected sex...(I'm assuming she had some unprotected sex based on this statement: But she's fearful that he didn't put the condom on in a timely manner.)

    I'm guessing she's an educated adult...I really don't feel sorry for her in this situation...
  • _
    _ Posts: 6,657
    inmytree wrote:
    Call me callous, but the main barrier in this story is your friend's poor planning and her choice to have unprotected sex...(I'm assuming she had some unprotected sex based on this statement: But she's fearful that he didn't put the condom on in a timely manner.)

    I'm guessing she's an educated adult...I really don't feel sorry for her in this situation...

    I wouldn't say she had poor planning or unprotected sex. She used two methods of contraception: condoms and the withdrawal method. Most people would probably view this as a perfectly reasonable contraceptive effort. She's just trying to go the extra mile and be hyper-vigilant to decrease her risk even further, and the system doesn't allow for that.

    EDIT: The system does allow for it - if you're wealthy.
  • Lizard
    Lizard So Cal Posts: 12,091
    There's only a small window during the month that you can get pregnant. Is she sure she was even in that window? She could be worrying for naught.
    So I'll just lie down and wait for the dream
    Where I'm not ugly and you're lookin' at me
  • _
    _ Posts: 6,657
    Lizard wrote:
    There's only a small window during the month that you can get pregnant. Is she sure she was even in that window? She could be worrying for naught.

    No, she's not sure. After having been on the pill for so long, she doesn't have a regular period. Regardless, I don't think she'd want to take the chance.
  • redrock
    redrock Posts: 18,341
    scb wrote:
    redrock wrote:
    scb wrote:
    And the UK has a lower rate of unintended pregnancy than the US. Coincidence? I don't think so.

    Though it still has the highest rate of teenage pregnancy in Europe.... Education WITH free contraception... that would be even better!

    Yes, education too would be ideal. Do the other countries in Europe have both free contraception & education?

    I wonder what the UK teen pregnancy rate is compared with the US.

    Not sure what the rate is (I could google...) but I know the US is much higher than the UK. Also, I don't know of all European countries, but certainly the ones I lived in do not offer free birth control. Education is key in those countries and girls are much better followed (thus lower rate of cervical cancer, etc.).
  • TravisTheSky
    TravisTheSky Posts: 615
    scb wrote:
    I run our EC hotline

    Perhaps your friend could call your emergency contraception hotline?
    "May you live in interesting times."
  • _
    _ Posts: 6,657
    TravisTheSky wrote:
    scb wrote:
    I run our EC hotline

    Perhaps your friend could call your emergency contraception hotline?

    She did, by calling me. That's how I got involved & one reason I feel so frustrated about not being able to help her.

    Another noteworthy point regarding emergency contraception: Normally one can just take extra regular birth control pills, but the insurance companies don't allow for that either. If you take extra pills, your pack runs out early. The insurance companies refuse to refill them before the date they SHOULD have run out. So that just leaves the person uncovered for a week or so at the beginning of the next cycle, creating a two-week (or more) window when they could get pregnant (right during ovulation time).

    I just think it's bullshit that people's medical care/decisions should have to be based on insurance company policies rather than on what they & their doctor decide is best for their health. :(
  • inmytree
    inmytree Posts: 4,741
    scb wrote:
    inmytree wrote:
    Call me callous, but the main barrier in this story is your friend's poor planning and her choice to have unprotected sex...(I'm assuming she had some unprotected sex based on this statement: But she's fearful that he didn't put the condom on in a timely manner.)

    I'm guessing she's an educated adult...I really don't feel sorry for her in this situation...

    I wouldn't say she had poor planning or unprotected sex. She used two methods of contraception: condoms and the withdrawal method. Most people would probably view this as a perfectly reasonable contraceptive effort. She's just trying to go the extra mile and be hyper-vigilant to decrease her risk even further, and the system doesn't allow for that.

    EDIT: The system does allow for it - if you're wealthy.

    how did the "system" disallow her from personally purchasing the morning after pill...?
  • _
    _ Posts: 6,657
    inmytree wrote:
    scb wrote:
    inmytree wrote:
    Call me callous, but the main barrier in this story is your friend's poor planning and her choice to have unprotected sex...(I'm assuming she had some unprotected sex based on this statement: But she's fearful that he didn't put the condom on in a timely manner.)

    I'm guessing she's an educated adult...I really don't feel sorry for her in this situation...

    I wouldn't say she had poor planning or unprotected sex. She used two methods of contraception: condoms and the withdrawal method. Most people would probably view this as a perfectly reasonable contraceptive effort. She's just trying to go the extra mile and be hyper-vigilant to decrease her risk even further, and the system doesn't allow for that.

    EDIT: The system does allow for it - if you're wealthy.

    how did the "system" disallow her from personally purchasing the morning after pill...?

    For one thing, there's a difference between failing to allow for something and DISallowing it. I didn't say the system DISallowed it; I said it doesn't allow for it.

    I'm saying that the system, whose purpose is to provide a means for people to get healthcare, doen't work. Instead, it doesn't cover all pregnancy prevention medication, leaving it available only for women with an extra $50 to spare. It should be FACILITATING pregnancy prevention - that's what it's there for. (Plus, it's just stupid to not cover all contraception when, if a woman gets pregnant, the cost to the insurance company will be even greater for pregnancy.) Instead, it can create a barrier. (If my co-worker didn't pay hundereds of dollars per month for health insurance, she would have had the money to pay $50 for this pill.)

    THE HEALTHCARE SYSTEM DOESN'T WORK PROPERLY. That's my point.

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