Health

Health plans slow to adopt birth control law

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Camila Gonzalez was thrilled to learn that, under a new California law, she could get a one-year supply of birth control pills at the pharmacy and her insurance plan would cover it.

But in her case, that's easier said than done. The 25-year-old, who lives in Mar Vista, says her insurance company, Anthem Blue Cross, refused to cover her prescription, and has given her different excuses as to why.

"If a state law entitles you to something, you should be able to get it," Gonzalez says. "You shouldn't have to spend multiple hours on the phone with different entities, trying to make that happen. It's pretty ridiculous." Anthem has not responded to a request for comment.

The group that oversees Title X family planning services in California and the agency that regulates managed care health plans say they have seen evidence that some insurers are not complying with the new law. The insurance industry acknowledges there have been "hiccups" in implementing the measure; it blames logistical challenges and says eventually all insurers will cover the 12-month prescriptions.

Essential Access Health, which administers the state's Title X federal family planning program, has received reports similar to Gonzalez's from between 10 and 20 patients, providers and online pharmacies, says spokeswoman Amy Moy. But she says the group's research indicates that the problem is "widespread."

The lack of compliance extends to Medi-Cal managed care plans and private health insurance plans, adds Moy.

The California Department of Managed Health Care has received six complaints regarding insurers' refusing to cover the one year's supply of birth control, says spokesman Rodger Butler. "Keep in mind this data is preliminary and subject to change," he adds.

Charles Bacchi, president and CEO of the California Association of Health Plans, says snafus like the one Gonzalez has experienced can be attributed, in part, to the short period between the signing of the law in September and its implementation in January. He says insurance companies aren't accustomed to approving and distributing a year's supply of medication, so it will take time to educate the plans and any contractors who deal with pharmacy benefits about the law.

"It wouldn't surprise me if there were some hiccups along the way," Bacchi says. "But at the end of the day, any problems will get ironed out and people will be able to receive this coverage."

The organization opposed the bill when it was moving through the legislature.

He clarifies that the law applies to plans "issued, amended, renewed, or delivered" on or after Jan. 1, so some people, like those who work for small employers, may not be eligible for this benefit until later in the year. And some people, like those who work for self-insured companies, aren't eligible for the provision.

Moy, with Essential Access Health, acknowledges the law is in its infancy.

"We're hopeful that with more education, that health plans will move more into widespread compliance across the board," she says.

The organization is encouraging patients to file grievances with their plans when they believe they've been wrongfully denied their year's supply of birth control, she says. 

Camila Gonzalez filed a complaint about Anthem's denial of coverage with the University of California, which provides her insurance. She says she's still trying to get the company to approve coverage for her pills.

The Department of Managed Health Care's Butler says consumers who encounter this problem and are dissatisfied with their health plan's response (or if their health plan fails to resolve the issue within 30 days) can contact the Department's Help Center at 888-466-2219 or at HealthHelp.ca.gov.  

Moy says dispensing a year's supply of birth control is a cost-effective strategy.

"Studies show that dispensing a 12-month supply of birth control at one time can help reduce a woman's odds of having an unintended pregnancy by 30 percent," Moy says.

It would also reduce stress for women like Camila Gonzalez, who takes birth control to manage severe pain during menstruation.

She says she carves out time each month to pick up her pills at the pharmacy. But she says having a one-year supply "would free up time in my life. It would just be so much easier if I could just not worry about it for a year."