The CVS Prescription Drug Plan is the first in the United States to cover non-prescription contraceptives, eliminating a potential cost barrier for many women.
CVS Caremark, the company’s pharmacy benefit manager (PBM), said Opill will be added to its list of preventive services oral contraceptives in April 2024, meaning it will be covered at no cost to many sponsors. Stated.
Opill is available over-the-counter at CVS Pharmacy starting April 1st. CVS is the first major pharmacy benefits manager to cover Opill, which could open the door to even broader coverage.
PBMs are intermediaries in the prescription drug supply chain that negotiate discounts with drug companies on behalf of insurance plans. PBMs decide which drugs go on a list of covered drugs, called a “formulay,” and how much patients have to pay for them.
Three PBMs dominate the U.S. market: CVS Health’s Caremark, UnitedHealth’s Optum Rx, and Cigna’s Express Scripts.
The Affordable Care Act requires insurance companies to cover preventive services, including certain types of contraception, only if prescribed. Insurance companies typically do not cover over-the-counter (OTC) products.
Although some states require state-regulated private health insurance plans to cover OTC contraceptives, these rules do not apply to most employer-sponsored plans.
“Perrigo is excited to have Caremark join our efforts to increase access to safe and effective contraceptives like Opil for women and those who want them. “We recommend checking with your insurance company or personal plan to understand what coverage is available for you with Opil,” said John C., executive vice president and head of consumer self-care America for Perrigo, Inc., the manufacturer of the pill. President Triona Schmelter said. Statement to The Hill.
Research shows that even small cost barriers can pose significant challenges to accessibility. Uninsured or underinsured people still have to pay out-of-pocket costs, but manufacturers have patient assistance programs in place to help defray costs.
The recommended cost for one month of Opill is $19.99, but the company lists a three-month supply cost at $49.99.
A survey conducted in 2022 by the health policy research group KFF found that nearly 40% of women of reproductive age would be willing to pay between $1 and $10 per month for such drugs, and 34% would pay up to $20. It turned out that he was willing and able to pay. per month. But only about 16 percent are willing to pay more than $20 a month.
Opill was approved in July as the first OTC oral contraceptive in the United States. Opill is up to 98 percent effective in preventing pregnancy when taken as directed at the same time each day.
Reproductive health experts say the availability of oral contraceptives without a prescription could be a game-changer, especially for young women and women in rural and underserved areas. It has said.
Efforts to make contraceptives available over the counter have been going on for years, but the movement took on added urgency after the Supreme Court struck down Roe v. Wade and abolished the constitutional right to abortion. Increased sex.
The ruling also made it difficult to separate the issue of contraception from the politics of abortion.
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