What you need to know about SCOTUS, the Affordable Care Act and its effects on access to birth control…

What you need to know about Birth control in 2020:

• Get it before the ACA is reversed.
  • You can get a year’s supply in some states.
  • Get prescription emergency contraception too!
• How you can help protect access to birth control.
• There’s a new ring, a new patch and a new progestin-only pill.

If you have a uterus and are of childbearing age, you may want to consider having an IUD or implant inserted now.. Why? Because on November 10, the United States Supreme Court (SCOTUS) began hearing arguments in California v. Texas, which could result in the Affordable Care Act (ACA) being rendered unconstitutional.

What is the link with access to birth control? Under the ACA, all birth control methods approved by the FDA for people with a uterus must be covered “free,” meaning there is no co-payment or deductible. However, if the SCOTUS takes down the ACA, this could end.

The ACA’s birth control mandate has saved women and their families millions of dollars. It is estimated that in the first year the ACA’s birth control mandate was in effect, it saved women $1.4 billion. “The average pill user saved $254.91 per year.” Prior to the ACA, out-of-pocket expenses for birth control accounted for 30-44% of women’s out-of-pocket health care expenses. After the ACA, the women could spend that money on rent, food, etc. By increasing access to birth control, we reduce abortion and unplanned pregnancies, which translates into better economic opportunities and better education for women and their families.

If you are taking the birth control pill, patch or ring, know that in 17 states you can get a year’s supply of contraceptives at a time, so consider getting as many contraceptives as you can now. By law, these states require insurance to provide a one-year supply of birth control pills at a time: California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New York, Oregon, Rhode Island, Vermont, Virginia and Washington. Contact your prescribing physician to write out the one-year supply. Let your provider know that “it’s the law” in your state. (You can request 13 or 17 pill packs, 13 rings or 39 or 52 patches.)

If you’re having trouble getting a year’s supply because your insurance won’t, call your insurance and say “it’s the law.” If that doesn’t work, contact CoverHer.org, a project of the National Women’s Law Center. They have sample scripts to discuss with your insurance companies and letters you can write.

If you have a uterus and are of childbearing age, get prescription emergency contraception now. Again, the ACA covers it with no co-pays or deductibles, so it’s “free”. Prescription emergency contraception (Ella) works better all the time and for BMIs of 26-35 compared to Plan B and its generics. If you have a BMI of 26 or more, be aware that Plan B and its generics probably won’t work, so please CHECK your BMI.

What can you do if you support people whose wombs have access to “free” birth control (no copayments, no deductibles)?

Tell SCOTUS: #KeepTheACA #SaveTheACA. Chief Justice John Roberts is known to be receptive to public opinion and does not want to go down in history as a bad Chief Justice. So PROTEST, take to social media and make it clear: the ACA benefits the public, and we want it to stay.

Tell insurance companies and state government officials: It’s fiscally smart and morally right to cover birth control. So even if the ACA is overturned, nothing stops insurance companies from providing birth control with no co-pays or deductibles, and nothing stops politicians and elected officials from passing laws requiring a “free” coverage. It is much cheaper to cover birth control than to pay for an unplanned pregnancy. It costs $800 for an abortion, $10,000 for a vaginal delivery, and $40,000 for a caesarean section. This does NOT include prenatal and postnatal care, health visits, ultrasounds, lab tests, etc. For every dollar the government spends on birth control, it saves $7 on health care costs.

Kudos to the 29 states and Washington, DC that mandate birth control coverage. Kudos to the 16 states and Washington, DC that passed laws to keep the birth control mandate in place even if the ACA is reversed. Check your status here.

Long-acting reversible contraception (LARC) and permanent contraception/sterilization are expensive but effective.

An IUD/implant can cost $1,300, so get an IUD or implant NOW if you’re considering it. If you’re considering permanent birth control, a tubal ligation can cost up to $6,000, while a vasectomy costs just $1,000 and is far less invasive and more effective.

According to Contraceptive Technology 2018, the table below provides statistics on typical failure rates for these options:

*Not covered by the ACA but covered by Illinois, Maryland, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington.

To learn more about these methods, click here.

Hormonal IUDs lead to lighter periods (70% of users) or none (30%). The copper IUD causes more cramping and more blood loss, but it’s a good option if you can’t use anything with hormones (i.e. if you have a medical condition heart disease, blood clot disorder, etc. Discuss this with your doctor first.).

What’s new in birth control?

There is a new contraceptive vaginal ring, a patch and a progestin-only pill.

The new vaginal ring is Annovera, which carries a new segesterone progesterone and a very low dose of estrogen (13 mcg per day). The advantage of the new segesterone progesterone is that it has no androgenic side effects like acne, effects on blood lipids, hairiness, etc.

However, this method may not be best for those under 30. The concern is that this level of estrogen can negatively impact women under this age. A pediatric endocrinologist, pediatric adolescent gynecologist, and Stanford Teen Physicians recommend at least 30 mcg of estrogen for birth control pills because research has shown that lower levels lead to decreased bone mineral density.

Annovera is placed intravaginally for 21 days, then removed and out of the body for a week (during which the user will experience withdrawal bleeding). It has not been tested for continuous use (jumping periods).

The cost without insurance is around $2000 and the cost with insurance and under the ACA should be “free” (no co-pay, no deductible).

You may want to try the one month ring (NuvaRing, EluRyng) to see if you like a vaginal ring before trying Annovera.

The new contraceptive patch is called TWIRLA, which contains levonorgestrel and ethinylestradiol. A woman uses one patch per week for three weeks, then in the 4th week no patch is needed (when withdrawal bleeding occurs).

Note: if your BMI is 25-30, this might not work as well. And if your BMI is 30 or more, the manufacturer advises against using it because:

1. It doesn’t work as well

2. It puts you at a higher risk of a blood clot.

The concern about the patch is that previous studies have shown that the risk of developing a blood clot [venous thromboembolism (VTE)] is twice as likely on the patch as on standard birth control pills. This is thought to be because the hormone passes through the skin and avoids having to pass through the stomach.

The advantage of this patch is that it is slightly lower in estrogen (30 mcg versus the 35 mcg Xulane patch). However, users will most likely still experience higher blood levels than with birth control pills. The main side effect observed is breast tenderness compared to birth control pills, but this was similar in level to birth control pills after the 1st month.

There is also a new progesterone pill (POP): Slynd. The advantage of this pill is that it has a much more forgiving window of effectiveness. For most POPs, if you are three hours late, you should abstain from heterosexual intercourse or use backup for the next few days and use emergency contraception if you have had heterosexual intercourse in all three days previous ones. However, Slynd has a 24-hour dosing window, like “regular” birth control pills, which contain estrogen and progesterone. The main disadvantage of Slynd is its cost: $193 to $268 per month compared to regular birth control pills at $15 per month or other POPs at $8 to $30 per month. Also, the progesterone in Slynd is drospirenone, which is not good for people with kidney problems. Generally I like to make sure the patient can drink eight glasses of water a day as this can have a diuretic effect which can lead to headaches if the patient does not drink enough water.

For more information on the birth control options available, visit Pandia Health.

Dr. Sophia Yen is co-founder and CEO of Pandia Health, the only #WomenFounded, #WomenLed, #DoctorLed birth control delivery company.