Prices up for birth control

Joseph Mance remembers a time when packets of birth control pills cost $8 each.

Today he… Joseph Mance remembers a time when packets of birth control pills cost $8 each.

Today he is trying to spread the word to his student clientele that prices have hiked up once again, this time to the $40 range.

“I hate telling these kids, ‘We’re raising your pill price,'” he said with a troubled look. “It’s like pulling a gun on them.”

Every winter, Mance, chief pharmacist at Pitt’s Student Health Service pharmacy, sees pharmaceutical companies raise the price of their products, causing patients to pay more out-of-pocket. Recently, student clinic prices of four popular contraceptive products – Ortho Tri-Cyclen Lo, Nuva Ring, OrthoEvra and Dessagin – have increased from about $15 per pack to prices in the $40 range.

The price increase took effect as a result of legislation that excludes student health clinics from receiving the discounts offered to other clinics, including family planning centers who serve the nation’s most vulnerable patients, who generally have fixed incomes and little or no insurance. The Deficit Reduction Act of 2005, which was enacted in February 2006, limits which health care providers qualify to purchase drugs at “safety net” provider prices – which are 10 percent of average cost or less.

Pitt’s Student Health pharmacy does not participate in the federal drug discount program known as the 340B drug discount program. Under this program, drug manufacturers must offer qualified entities, including some family planning clinics, deeply discounted prices on drugs. The Deficit Reduction Act limited which health care providers could receive low-cost drugs to entities that participate in the 340B program, as well as a few other government-funded programs. Therefore, Pitt’s Student Health no longer qualifies to receive these low prices.

Manufacturers can still sell drugs at low prices to clinics that do not participate in the 340B program, but doing so will lower their prices to other federal purchasers like Medicaid.

Gloria Vanderham, communications manager for Ortho Women’s Health and Urology, said that the company does not have any control in deciding who qualifies for the low prices. Ortho notified ineligible clinics in November 2006 of the new legislation updates to make sure their clients had time to prepare.

Since Mance received the letter that informed him of the price increase, he stocked up on the affected products at discounted price before Dec. 17 so he could sell them to students as long as he had the supply. He and his team have also been warning every patient that comes in to purchase any of the four products.

He hopes that they haven’t missed telling anyone.

“We’ve tried to help people for 30 years here, but sometimes the situation is out of your hands,” Mance said about the price increases. “We really struggle to be the least pricey.”

He said that most students opt to pay for their products regardless of cost because student health pricing is still cheaper than alternative pharmacies like CVS, where product price ranges from $28 to $60 for uninsured patients. The cost of Ortho Tri Cyclen Lo is $56.99 at CVS.

Mance also suggests that patients consider switching to a generic brand of birth control, which would come cheaper.

But not all products have a generic counterpart, including Ortho Tri Cyclen Lo, and to some patients, messing around with their products is not an option.

Every woman is slightly different in which birth control will work for her, said Jennifer Lockwood-Shabat, director of public policy for the National Family Planning and Reproductive Health Association. Products such as Ortho Tri-Cyclen Lo do not come in generic form.

“In some cases, this particular pill might be the one that works best for that individual,” she said.

Lockwood-Shabat has been working with members to try to remove the provision to the Deficit Reduction Act in hopes that they will allow clinics to go back to their discounted prices.

“We’re hopeful that with a Democratic change, we will be able to make some headway on this provision,” she said.

Lon Newman, executive director for Family Planning Health Services, is also active in the fight for lower priced contraception. On Feb. 1, he will attend a drug pricing work group to discuss family planning issues to bring up in the NFPRHA board meeting on Feb. 2.

With NFPRHA, Newman is working towards getting two bills passed – The Unintended Pregnancy Prevention Act and the 340B Revision and Expansion Act. The first would make it easier for people to have access to the Medicaid family planning waiver program, which allows women ages 15 through 44 to receive free reproductive services, including contraceptive services and supplies. According to Newman, students in college would qualify for these free services.

Wisconsin, where Newman is public affairs chair for the Wisconsin Family Planning and Reproductive Association, is a major player in family planning. Wisconsin is one of 24 states that participate in the Medicaid family planning waiver.

“Wisconsin has so much vision,” he said, referring to family planning service support from their state government. “You can do it in Pennsylvania, too,” he said.

The second bill would make sure family planning and other clinics, including student health clinics, would have access to low price hormonal contraceptives.

“Someone has to start talking to people who understand how family planning works,” he said.

Newman suggests that, in order to bring the Medicaid family planning waiver to Pennsylvania, students must get politicians “on board.”

“I hate to say it, but it’s all on you,” he said.

Newman expressed a concern that young women often get forced to pay whatever necessary to receive contraception or any reproductive health service, while most young men don’t carry such a burden.

“Most women don’t get pregnant without someone from the other sex,” Newman said with a laugh. “We don’t believe in immaculate conception for all.”

Jaime Sidani, health educator for Pitt’s Student Health Services, acknowledges Newman’s point and often suggests that women in relationships who are on birth control ask their partners to pay half of its cost.

“Any sexual decision should be a joint decision,” she said.

Sidani offers 40 minute information sessions to students who need guidance in contraceptive decisions. She explains different methods and products available, their side effects and any other “trouble-shooting” issues.

Sidani said she believes birth control use is a personal decision and urges sexually active students to use condoms. She said that for the women who do choose to use birth control, the pharmacy, and especially Mance, will do everything to accommodate them.

“He is really there for the students,” she said.

To Mance, helping students is one of the greatest feelings in the world.

Until he runs out of his discounted supply, he will continue to encourage students to pursue his three step plan in cutting the monthly cost of contraceptives. With almost 30 years of experience at the student pharmacy, he can safely say that this is not the last time he will have to inform students of product price increases.

“You are better off loading up right now,” he said. “Because nothing will be cheaper in the future.”