Making Drug Prescription Coverage Fairer for Women.

"Insurance companies pay for Viagra, but not for birth control. It's not fair. There's nothing right about it," says Missouri Speaker Jim Kreider, who successfully passed legislation last session mandating insurance coverage for contraceptives.

Since the male impotence drug Viagra has been covered by many insurers, coverage for contraceptives is a hot topic in legislatures. An estimated 10.4 million American women use oral contraceptives, and millions use other methods to prevent pregnancies. Nonetheless, nearly half of the 6.3 million pregnancies in the United States are unintended. Although states have been required to cover family planning services for Medicaid beneficiaries since 1973, many private insurance plans do not cover the costs of birth control pills or devices.

At least 19 states require insurers who cover prescription drugs also to offer coverage for prescription contraceptives. Some exempt employers who object to such coverage for religious reasons. Last session at least 25 legislatures debated bills on insurance coverage of contraceptives. Only Missouri, New Mexico and Texas passed laws. Discussion turned contentious in many legislatures. "It's difficult to enact a bill like this," Kreider explains, "but we were successful in bringing everyone together--pro-life, pro-choice, insurance companies and legislators."

Advocates for insurance mandates argue that contraception should be considered basic health care. "There is a minimal fiscal impact," says Representative Mimi Stewart of New Mexico. "There are only slight fiscal increases in the short run. In the long run, it will save money by preventing pregnancies.

Senator Jeff Wentworth of Texas says the move saves money because "it's cheaper than babies are." According to the Alan Guttmacher Institute, an employer will spend an additional $1.43 per month per employee for contraceptive coverage compared to $5,000 for a healthy pregnancy and birth or up to $1 million for a premature birth for that same employee should she become pregnant.

Those who oppose requiring coverage for contraceptives argue that insurance premiums will rise, increasing costs to employers and individuals. Missouri Senator Larry Rohrbach says, "Mandating coverage is an inefficient way to buy contraceptives. Contraceptives are not expensive, but mandates are. I don't like telling people the type of coverage they have to buy. People can determine for themselves the type of coverage they want. It's more an issue of political correctness than of common sense."