As the anniversary of Roe v. Wade passes this week, we should recognize the significant reproductive rights women have gained over the past few decades and recent years. In particular, Maryland women and their doctors should be aware that as of this month, patients can benefit from the landmark Maryland Contraceptive Equity Act (MCEA).
The MCEA applies to state-regulated plans, which includes state-regulated insurers and state Medicaid. Women with these types of insurance coverage can now receive: over-the-counter emergency contraception (Plan B) free of charge and copay-free prescribed contraception of any type, including six months’ worth of birth control pills at a time or long-acting birth control (Depo-Provera shots, intrauterine devices or subdermal contraceptive implants) without preauthorization from insurers. The MCEA doesn’t just provide benefits for women; it also ensures copay-free male sterilization (vasectomy).
As an Ob/Gyn practicing in Baltimore, I was thrilled to hear about the law because these measures have the power to significantly reduce barriers in accessing family planning methods and to therefore reduce the risk of unintended pregnancy.
In Maryland, about 58 percent of all pregnancies are unintended. Ninety-five percent of unintended pregnancies are attributed to women who do not use contraception or may have gaps in contraceptive use due to reasons including inability to afford a method or pick up monthly refills for certain methods on time.
Many barriers to consistent contraceptive use are eliminated with the MCEA. Just last week, I saw a woman who needed a refill of her oral contraceptives. Like all of my patients, she is busy, and she is more likely to successfully prevent pregnancy when she doesn’t have to make a separate, unnecessary trip to the pharmacy each month to pick up her birth control. Because of the MCEA, I was able to write her prescription for six months’ worth of pills rather than the usual one month’s worth, saving her five trips to the pharmacy.
The benefits of the MCEA don’t just have to do with convenience and saving time. I have already seen how the MCEA changes the lives of women and families in Maryland. Just recently, I cared for another woman who wanted an IUD (intrauterine device) for contraception. She is on Medicaid and wants to wait a few more years to have her second child. The IUD is more than 99 percent effective in preventing pregnancy and is a key contraceptive method in helping many women plan their lives. I was able to evaluate this patient, examine her and place the IUD in less than an hour because we did not need to check for insurance coverage or wait for preauthorization (which can take days) for this method. Even better, she walked out of the office with an effective birth control method for the next five years with the knowledge that she would not be getting a bill in the mail asking for a co-pay.
Another patient saw me in the office to discuss tubal ligation for permanent sterilization. She struggled with many medical issues and was not an ideal candidate for the procedure because it involved surgery in the abdomen and general anesthesia. She also discussed with me that her husband was considering a vasectomy, a lower-risk procedure that can be done in the office. Because of her health issues, I discussed that vasectomy would be the safest permanent contraceptive option for them as a couple and that under the MCEA, vasectomy would be copay-free for them. With this law, we not only enable women better access to birth control options, but also their partners.
From my interactions with patients and other physicians, I know that many Marylanders are not aware of this landmark law, which recently went into effect. Patients should know their new rights to contraceptive access and raise concerns with NARAL Pro-Choice Maryland if co-pays or pre-authorizations are occurring because these barriers should have been eliminated. Physicians and pharmacists should be well-versed in the provisions under the MCEA to better facilitate patient care.
Maryland is at the forefront of expanding access to birth control, but we must spread the word and work together for the MCEA to have real-life impact.
Dr. Jessica K. Lee (JessicaKLeeMD@gmail.com) is an Ob/Gyn in Maryland and a fellow with Physicians for Reproductive Health.