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Because of high cost, new contraceptive may not be option for some, doctors say


Norplant, the first new contraceptive available to American women in 30 years, will slowly make its way into Baltimore-area doctors' offices over the next few weeks -- but some physicians say its high price may be an obstacle to women who lack insurance coverage.

Some 60 doctors showed at a Planned Parenthood-sponsored seminar in Towson yesterday to learn how to implant, monitor and remove the device and how to counsel patients seeking it. Norplant is a system of six matchstick-sized tubes that are injected under the skin of the upper arm.

The tubes release a trickle of contraceptive hormone into the bloodstream for five years but can be removed any time a woman wants to become fertile.

"It gives five years of extraordinarily effective birth control," Dr. George Huggins, chief of obstetrics and gynecology at the Francis Scott Key Medical Center, said yesterday at the training session, held at the Quality Inn.

"There's nothing short of sterilization that will give people the sort of assurance they can get from Norplant. But it's a very expensive method up front."

The "up front" cost at Francis Scott Key will be $850 -- Norplant's $350 wholesale cost and doctors' $500 charge to counsel patients and implant the device. While Medicaid and some health maintenance organizations have decided to cover the device, Blue Cross-Blue Shield of Maryland -- the state's largest health insurer -- has not yet decided if it will do likewise.

"We're seriously looking at it, but we don't have a final decision," Liz Ziemski, a Blue Cross-Blue Shield spokeswoman, said yesterday. The company covers the birth control pill and intrauterine devices under some, but not all, of its policies.

Meanwhile, Planned Parenthood will begin inserting the device into patients within the next two or three weeks, according to Dr. Doris Tirado, the medical director. The group, she said, has not yet set its own price but is looking for ways to help uninsured women obtain Norplant -- possibly by subsidizing some portion of the cost.

Dr. Huggins said he plans today to deliver the device to two women, his first Norplant patients at Key. Dr. Huggins, who is active in international family planning circles, has inserted the device for several women in Indonesia, where a half million women have received Norplant over the last decade.

The U.S. Food and Drug Administration approved the first domestic sales of Norplant Dec. 11. Until recently, few doctors were trained to deliver Norplant to patients.

Dr. Huggins said the cost is actually less than five years of birth control pills, but the lump-sum cost may be beyond the reach of women who don't have insurance coverage and are not poor enough to qualify for Medicaid.

Physicians have said they expect Norplant to appeal to young women, even teen-agers, who are not ready to start a family -- and to older women who have had all the children they want. Some doctors said young women will opt for other methods once they learn about its occasional side effects -- irregular cycles, spotting between periods, heavier bleeding and missed periods.

The menstrual irregularities are harmless but may alarm teen-agers more than older, more educated women, Dr. Huggins said.

"I think there will be people who want to use it, but I don't think there will be a huge demand," said Dr. Sam Ackman, an obstetrician-gynecologist at the Greater Baltimore Medical Center who has his first two Norplant patients scheduled for Thursday.

Norplant and the pill each have their benefits and drawbacks, he said.

With Norplant, women don't have to worry about taking a pill every day and can expect exceptionally effective birth control. With the pill, he said, irregular bleeding is less common and lasts only a few months.

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