We’ve written before how the Affordable Care Act covers all female contraceptives but not a single male contraceptive. This omission is particularly odd considering men only have two options they can purchase—condoms and vasectomies. A vasectomy is cheaper, less invasive, and more effective than a tubal ligation. And male condoms are not only popular for pregnancy prevention but are overwhelmingly the most typical approach to STI protection. The error in these omissions is glaring.
The road for what’s included in the Affordable Care Act is a bit complicated.
You see, the Affordable Care Act automatically includes recommendations from the U.S. Preventive Services Task Force (USPSTF) on contraceptive coverage. And that’s organized through the Department of Health and Human Services (DHHS). To make things more complicated, DHHS uses other organizations to make its recommendation. Last time they took their recommendation from the Institute of Medicine. This time they switched, and they’re taking their recommendation from the American College of Obstetricians and Gynecologists (ACOG).
We’ve been tracking this process and have been working with our contacts to push for their language to include male contraceptives. Plus, your participation on Change.org has helped us make our case!
And, believe it or not, it’s actually looking good.
Adam Sonfield from Guttmacher recently wrote an optimistic update in the Health Affairs Blog. He referred to the draft language by the ACOG.
Again, the ACOG is making the recommendation to DHHS, which affects the recommendation to the USPSTF, which is automatically incorporated into the Affordable Care Act. The important part to note is that the early link with the ACOG is expected to flow steadily through the rest of the chain without resistance—all the way to being law. One caveat is that there’s a one-year grace period before the recommendations become a reality, as pointed out in another thorough article by Adam Sonfield.
Let’s take a look at the relevant draft language (bold is ours) by the ACOG:
The full range of contraceptive and family planning services include the following: All contraceptive methods currently identified by the FDA, which include: (1) sterilization surgery for women and men; (2) surgical sterilization implant for women; (3) implantable rod; (4) copper intrauterine device (IUD); (5) IUD with progestin (all durations and doses); (6) shot/injection; (7) oral contraceptives (combined pill); (8) oral contraceptives (progestin only); (9) oral contraceptives (extended/continuous use); (10) patch; (11) vaginal contraceptive ring; (12) diaphragm; (13) sponge; (14) cervical cap; (15) female and male condoms; (16) spermicide; (17) emergency contraception (levonorgestrel); and (18) emergency contraception (ulipristal acetate); and additional methods as identified by the FDA. Instruction in fertility awareness-based methods, including the lactation amenorrhea method, for women desiring alternative, although less-effective methods. Counseling that allows for discussion of the full range of contraceptive options and emphasizes patient-centered decision making. The most appropriate choice to prevent pregnancy for a woman might include a vasectomy for her partner or use of male condoms.
Here are some points to highlight:
- Vasectomy is directly mentioned
- Condoms (both male and female) are directly mentioned
- The recommendation uses open language to keep the door open for new male contraceptives (and new methods for women)
The vasectomy recommendation seems like the easiest recommendation to make. It’s long-term, highly effective, and can have an upfront cost that can be a true barrier for many people. And for many couples, it’s a clear alternative to tubal ligation. It’s also a procedure men have to go directly through their doctors for.
The condom recommendation is a pleasant surprise. Many countries don’t cover condoms for free. But if this is coverage through insurance, how would that work with condoms?
Answer: You’d ask for a prescription from your doctor anyway. Over-the-counter birth control pills raised issue because of the fear that it wouldn’t get covered by insurance. But insurance can cover over-the-counter medication when you ask for a prescription. This is already done to cover Plan B, which is also over the counter. And this would work the same way for condoms.
The other component that’s encouraging is the open language. Although it certainly seems like our wait for a new male contraceptive is taking an incredibly long time, it will happen. We’re constantly identifying researchers and even potential funders as we build Male Contraception Initiative. Drug and medical device development is expensive and slow, but we will surely decrease the timeline from what it would be otherwise without our presence. If this language holds, this would help assure that when a male contraceptive does hit the market, it will be accessible.
We’re crossing our fingers that the draft language sticks. In the meantime, we’re happy to share this update, and we thank you again for your support.