Institute of Medicine recommends birth control without copays

The federal government should include “the full range of Food and Drug Administration-approved contraceptive methods” among preventive services that insurers would be required to cover without charging copays under the Patient Protection and Affordable Care Act of 2010 (ACA), recommends a report released July 19 by The National Academy of Sciences’ Institute of Medicine (IOM).

The ACA mandates that insurance plans cover patient cost-sharing services identified in the United States Department of Health and Human Services’ (HHS) comprehensive list of preventive services. The IOM report, undertaken at HHS’s request, recommends 8 additions to the list, including contraception and counseling, to address gaps in preventive services for women and further women’s health and well-being. HHS secretary Kathleen Sebelius will determine which benefits to include on the agency’s comprehensive list.

The IOM report advocates insurance coverage for all FDA-approved contraceptives, including emergency contraceptive pills, as well as sterilization procedures and “education and counseling for all women with reproductive capacity.” The report notes that “contraception is highly cost-effective” because it prevents much more expensive pregnancies. Unintended pregnancies accounted for almost half of pregnancies in the US in 2001; almost 40% end in abortion.

“This report provides a road map for improving the health and well-being of women,” says Linda Rosenstock, chair of the committee that issued the report and dean of the School of Public Health, University of California, Los Angeles. The 8 services we identified are necessary to support women’s optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness.” In addition to contraception, services recommended in the report include screening for gestational diabetes and human immunodeficiency virus, human papillomavirus testing, counseling on sexually transmitted diseases, lactation counseling and equipment to promote breastfeeding, screening and counseling to prevent and detect interpersonal and domestic violence, and yearly preventive care visits.

Obstetricians and gynecologists and public health experts have endorsed the IOM report. The US Conference of Catholic Bishops and some conservative organizations, such as the Family Research Council, oppose the contraceptive recommendations.