Just saw this Vox News article – https://www.vox.com/policy-and-politics/2017/10/6/16435382/trump-birth-control-mandate

And while this is a real bummer, it’s unlikely to dramatically move the market – here’s why.

On the one hand, REQUIRING employers to cover birth control allowed WAC and net price increases for these products. This was because many payers and employers were fearful of implementing ‘too much’ control in one of women’s eight preventive health benefit markets. This pretty clearly distorted the market, if one is solely focused on pricing dynamics.

On the other hand, insurers, payers, employers, and most importantly WOMEN really like this benefit. And, looked at from any perspective, birth control is a very cost effective way to manage BOTH health and non-healthcare resources. (yeah, I’m going with the Nixon reference here, just to point out how far we’ve come, baby!)

In fact, women who have the ability to delay their families make more money. There are too many cultural dynamics to detail here, and I don’t want to digress too much.

But, fortunately or unfortunately, like many of this White House’s initiatives, this is unlikely to do much at all. As noted in the article, it’s possible that large, religious universities MAY take this as an opportunity to stop covering birth control. But remember that women in those institutions are largely of age to revert to their parent’s coverage – until that portion of the ACA is repealed or replaced – and the coverage until 26 facet is HUGELY popular (85% support).

So, while companies MAY restrict coverage of birth control, how many actually WILL change their policies? Over time, I could see a slow change as payers and employers feel more confident about taking action here. But that may end up with even stronger Gx step edits and more limited coverage of brands (if they cover brands at all). Not wholesale failure to cover ANYTHING.

As payers and employers know, TAKING AWAY coverage is much harder than adding it. Women have come to LOVE this benefit. And, politics aside, women will be angry with their insurance providers if they see their coverage change and become more restrictive. Unfortunately, we aren’t rational actors when it comes to aligning our anger with the ultimate decision maker, especially in complex and obscure processes like this. Simple economics would state that they’d seek out plans providing coverage in subsequent years, even if those plans cost slightly more.

This will be interesting to watch develop. I want to voice my opinion that this will be greeted with a giant yawn. Let’s see!



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