Birth of a Problem

[August 1st, 2007]

Women pay more than men for haircuts and dry cleaning. They wait longer to use public restrooms.

And in the latest indignity—at least for the short term in Oregon—women at America's colleges and universities are paying more for birth control, thanks to a little-noticed provision of a complicated federal law, campus health officials say.

Practically overnight, the prices on some popular brands of birth control, previously dispensed at campus health centers at a manufacturer's discount for as little as $7 a month, multiplied by as much as three or four times earlier this year.

At several local schools, undergraduate students—including those with health insurance—are losing out. They're facing higher prices and fewer birth-control options on campus, and some of the students are only now finding out about the hikes, says a representative from Portland State University.

"The short-term effect is less choice, more money," says Michael Brody, director of Reed College's Health and Counseling Services.

The jump in birth-control prices is the result, oddly, of the Deficit Reduction Act of 2005, which President Bush signed into law in February 2006.

At the time, Bush said the act would save Americans money. "This important piece of legislation restrains federal spending—and it will leave more money in the pockets of those who know how to use it best, the American people," Bush said.

That is not how the legislation played out on the campuses of Reed, Portland State University, Lewis & Clark College and the University of Oregon.

(As a side note, Portland Community College doesn't have campus pharmacies and doesn't dispense birth control. PCC does offer free condoms — a service that won't be affected by the legislation there or at other campuses. The University of Portland, a Catholic school, doesn't offer its students condoms or birth control pills for religious reasons.)

The legislation passed by Congress calls on drug makers to offer Medicaid the same deep discounts on prescription drugs that it offers other healthcare providers.

Drug makers have responded to that requirement by no longer giving colleges and universities discounted deals on birth-control pills.

For example, the price of Ortho Tri-Cyclen Lo (one popular form of oral contraceptive) would have nearly tripled from $17 to $50 a month at PSU's Center for Student Health and Counseling, which does not mark up the price of prescriptions. Instead, when the health center ran out of its supply of the brand last spring, it did not restock the pill. The same goes for NuvaRing, a vaginal contraceptive whose price more than quadrupled from $7 to as much as $32 a month, according to Mary Beth Collins, the health center director at PSU.

Now students at PSU who still want those brands can get a prescription on campus. But they'll have to fill the prescription and pay the higher price at an independent pharmacy.

In anticipation of the price increase, Reed bought a stockpile of Ortho Tri-Cyclen Lo at the old price, meaning students at Reed will still have access to that brand at a discount when they return to school this month.

Interviews with a dozen female students at Lewis & Clark reveal price is an important factor when it comes to choosing a birth-control method. Several students said they relied on Planned Parenthood (which is still currently eligible for the deep discounts as a designated "safety-net" provider) because they can get birth control pills for free there. Options are important, says Rachael Berg, 20, a junior who filled her Ortho Tri-Cyclen Lo prescription last spring with the help of insurance for $2 a month.

"On drunken nights, condoms might not be used,'' Berg says. "And birth-control [pills] decrease the chances of an unwanted pregnancy."

Insured students at Oregon colleges and universities could find relief next January when House Bill 2700 takes effect. That bill, signed into law by Gov. Ted Kulongoski on May 30, requires health insurance plans offering prescription drug coverage in Oregon to cover birth-control pills. If a college student's plan has a low co-payment or no co-payment, out-of-pocket costs could fall to levels that are closer to the discounted prices.

Oregon Senate Majority Leader Kate Brown, a Portland Democrat who pushed for the law, says the unintended consequence of the federal rule change could be to dissuade college-age women from using birth-control pills. (One other possible unintended consequence for the anti-abortion Bush administration is an increase in unwanted pregnancies.)

"It's better for health care in general for preventative care to be accessible and as affordable as possible," Brown says.