The following article is an adaptation from a letter written to my private health insurer regarding its policy regarding non-PBS contraceptive drugs.
I recently submitted a claim for a private prescription for a non-PBS oral contraceptive pill and received a rejection email stating that this drug would only be covered if the primary reason for its use was ‘hormonal reasons’ rather than contraception.
From my research it appears covering non-PBS drugs used primarily for contraception is a widespread practice amongst Australian Private Health Insurance Providers. However, as a doctor and a patient, I quite frankly expect the policies of my health fund to be based on recent and accurate evidence.
I outline the following reasons for my request that my health fund cover non-PBS contraceptives:
- Contraception is a fundamental preventative health service
- Contraception prevents women from the health risks associated with unintended pregnancy1
- Evidence clearly shows that regular use of contraception prevents unintended pregnancy and reduces the need for abortion.2
- In its 2011 report ‘Clinical Preventive Services for Women: Closing the Gap’, the independent Institute of Medicine concluded that contraception is medically necessary to ensure women's health and wellbeing.3
- The risk of death in females aged 15 – 34 years from combination oral contraceptive pills is 1 in 1,667,000, which is the same as being struck by lightning4. This is compared to a 1 in 13,888 risk of maternal death in Australia (1 in 7,246 in indigenous women)4
- Contraception allows women to determine the timing and spacing of pregnancies. This acts in both protecting their health and improving the well-being of their children.5
- Contraceptive use saves money
- By avoiding the costs of unintended pregnancy and by making pregnancies healthier, contraceptives save millions in health care expenses annually. 6
- Unintended pregnancies are estimated to make up 38%7 of all pregnancies in Australia, which represents a significant financial burden for health providers
- Should I become pregnant, the expense of covering my pregnancy will cost the health fund far more than the price of the contraceptive pill.
- Contraceptive choice is an essential consideration
- The choice of contraception should not be determined by anything other than what is in the best interests of the woman’s health.
- Whilst there are less expensive oral contraceptive pills available, my choice of pill has been determined over many years of trialling different contraceptives and their side effect profiles. My choice of contraceptive is the most appropriate for me.
- It has been shown that women and couples are more likely to use contraception successfully when they are given their contraceptive method of choice8
- Family planning is essential to securing the health and rights of women
- A review of more than 66 studies conducted over three decades shows a woman’s ability to control her fertility plays a significant role in shaping women’s financial, professional and emotional lives.9
While many of the above reasons support an argument for all contraception types to be covered by Medicare, in the absence of the support from the government, my final reason outlines my expectation of my private health fund.
- A private health fund should support my choices for my wellbeing
- Many services accessed through private health insurance are based on choice, not necessity. I don’t need to be admitted to a private hospital and I don’t need designer frames for my glasses but I pay my private health premiums so that I can CHOOSE to.
- There is no reason why my choice of contraception should be treated any differently to this.
Contraception is not a medical luxury, it is a medical necessity. The idea that preventing unwanted pregnancy should somehow be removed from a woman’s health and wellbeing is a bizarre, Victorian- era sentiment.
I implore my private health insurer to change its policy to include non-PBS contraceptives and eagerly await their reply. In the meantime I will be contacting other health funds in search of one who will cover private prescriptions for my contraceptive pill.
References:
- Gossett DR, Kiley JW, Hammond C. Contraception is a fundamental primary care service. JAMA 2013 [cited 2015 Dec 24]. Available: www.ncbi.nlm.gov/pubmed/23677310
- Deschner, A., Cohen, S.A. Contraceptive Use Is Key to Reducing Abortion Worldwide. The Guttmacher Report on Public Policy 2003 [cited 2015 Dec 24] Available: heapol.oxfordjournals.org/content/11/2/83.full
- Independent Institute of Medicine (IOM). Clinical Preventive Services for Women: Closing the Gaps 2011 [cited 2015 Dec 24] Available: iom.nationalacademies.org
- Schwingl PJ, Ory HW, Visness CM. Estimates of the risk of cardiovascular death attributable to low-dose oral contraceptives in the United States. Am J Obstet Gynecol. 1999 [cited 2015 Dec 24] Available: http://www.ajog.org/article/S0002-9378(99)70182-1/abstract?refuid=PIIS0010782406000357
- AIHW: Humphrey MD, Bonello MR, Chughtai A, Macaldowie A, Harris K & Chambers GM Maternal deaths in Australia 2008–2012. [cited 2015 Dec 24] Maternal deaths series no. 5. Cat. no. PER 70. Canberra: AIHW.
- Gold, R.B. (2011). Wise Investment: Reducing the Steep Cost to Medicaid of Unintended Pregnancy in the United States.” Guttmacher Policy Review 14(3): 6-10. 2011 [cited 2015 Dec 24]
- C Reid. Family Planning NSW presentation: Unplanned Pregnancy. 2010. [cited 2015 Dec 24] Available: www.fpnsw.org.au/unplanned_pregnancy.pdf
- Frost, JJ, Darroch JE. Factors Associated with Contraceptive Choice and Inconsistent Method Use. Perspectives on Sexual and Reproductive Health 2008. [cited 2015 Dec 24]
- Sonfield A. The Social and Economic Benefits of Women’s ability to determine whether and when to have Children. 2013. [cited 2015 Dec 24] Available: www.guttmacher.org/media/nr/2013/03/21/index.html
