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Duke insurance to subsidize oral contraception in 2013

Although Student Health gives students access to free condoms, oral contraception can become expensive enough that some students switch to risky alternative methods, such as Plan B.
Although Student Health gives students access to free condoms, oral contraception can become expensive enough that some students switch to risky alternative methods, such as Plan B.

By August 2013, students who are part of the Duke-sponsored medical insurance plan may see a dip in the price they pay for birth control.

Students under Duke Student Health Insurance Plan, underwritten by Blue Cross Blue Shield of North Carolina, will have generic oral contraception completely covered, said Student Health Executive Director Dr. Bill Purdy. There are currently around 7,500 students who are on Duke insurance.

“Birth control pills are certainly the most common form of contraception for Duke women,” Purdy said. “It is important that we keep the costs as low as we can. I’d love it if we could give everything for free if that would promote better sexual health.”

The current prices of birth control pills vary nationwide. According to companies’ websites, pharmacies at Walmart and Kroger offer generic birth control pills for as little as $9 per month to benefit women without insurance, and the Planned Parenthood chapter in Durham offers prescriptions from $22 to $35 per month.

Dr. Kimberly Yarnall, director of medical services at Student Health, noted in an email Wednesday that most insurance companies require a copay for non-generic pills that can range from $25 up to $100 monthly, adding that mail-order delivery of drugs—which may be more convenient for college students—requires a 90-day prescription.

Students seeking to waive the Duke Student Health Insurance Plan with their own insurance plans are not required to have existing contraceptive coverage. Most insurance companies currently cover 80 percent of the costs for birth control pills, leaving the remaining 20 percent to the individual’s responsibility.

Additionally, college students are more likely to seek riskier methods of contraception when the price of contraceptive pills increases, according a 2011 study from the University of Michigan.

The study highlighted the dangers of increasing the price of oral contraception and concluded that more expensive birth control pills lead to riskier sexual behavior by college-aged women. The study used data from the National College Health Assessment and the 2006-2008 National Survey of Family Growth.

“Not having access to reliable forms of birth control or not being to afford them—that’s a problem,” said Brad Hershbein, co-author of the study and a Ph.D. candidate in economics at the University of Michigan.

Hershbein and co-author Emily Collins, also a Ph.D. candidate in economics, inspected women’s contraception usage and sexual behaviors after January 2007, when the Deficit Reduction Act of 2005 took effect and inadvertently allowed pharmaceutical companies to discontinue selling drugs at a price lower than the retail price. As a result, the average price of birth control pills increased by about $5 to $10 per month to $30 to $50 per month. At Duke, the act was the main factor in causing the Student Health pharmacy at Duke to close in 2009, the study reported.

The study indicates that college women were not more likely to increase condom usage. Instead, they more frequently sought contraceptive methods such as Plan B, a high-dosage emergency contraceptive, Hershbein said, adding that women also more often practiced non-medicinal forms of contraception such as the rhythm method—only engaging in sexual intercourse immediately after menstruation. Consequently, the number of unintended pregnancies rose.

In light of these results, Hershbein said he believes that the move to mandate birth control coverage as part of health insurance is “a step in the right direction.” Hershbein added that doing so will likely yield results that demonstrate a direct relationship between the price and usage patterns.

Purdy said data pertaining to the contraceptive usage patterns on campus—such as the number of contraceptive prescriptions filled or the number of condoms distributed—is not available.

The Women’s Center deferred comment to Student Health regarding contraception use at Duke and declined to comment further on the study.

Purdy said he recommends that Duke women keep open lines of communication with their partners to find a way to afford birth control.

“I understand that paying… can be a struggle, but that’s a choice that they’ll have to make then,” Purdy said. “And students can come in any time to pick up free condoms.”

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