Lessons learned from failed birth control law

Do’s and don’ts from Reproductive Equity Now

DRAWING LESSONS from a Massachusetts birth control law that failed to work as planned, a reproductive rights group released a toolkit on Monday offering a series of recommendations to lawmakers in Massachusetts and around the country on how to improve compliance with such legislation.

The report produced by Reproductive Equity Now said the so-called ACCESS law that was signed into law in 2017 was groundbreaking, requiring insurers to cover nearly all forms of birth control with no copays and directing that pharmacists fill 12-month prescriptions for birth control pills after an initial three-month trial.

Research indicates a 12-month supply of birth control instead of a three-month supply reduces by 30 percent the chance of an unintended pregnancy, according to the toolkit.

The law ushered in little change because few insurers, pharmacists, or patients knew anything about it. Pharmacists weren’t equipped to fill 12-month, renewable prescriptions. Patients didn’t know if they were covered; the law only applied to those covered by fully insured and not self-funded plans. And the state regulatory agency, the Division of Insurance, lacked adequate staffing and had “a general lack of knowledge about how birth control works,” according to the toolkit.

The first anyone heard about a problem with the Massachusetts law was a CommonWealth story early last year, which reported that only 300 women obtained 12-month birth control prescriptions in 2020. The CommonWealth story triggered a self-examination by all the parties involved, and also prompted the Legislature to provide funding for a public awareness campaign about the law.

“Securing funding for a public awareness campaign was made possible, in part, by the publicity generated by the CommonWealth magazine article and in part the leveraging of relationships at the State House,” the toolkit said.

The toolkit said the law had a number of serious omissions. There were no clear reporting requirements, no penalties for noncompliance, no funding for a public awareness campaign, and no language addressing pharmacy red tape issues.

“It is essential that the government body or agency tasked with implementation of the law also have the capacity to require annual or biannual reporting on requests, approvals, denials, and refills from each health plan,” the toolkit said. “This would allow for identification of noncompliant plans, implementation issues with the law, and also collect data which could help identify which populations might benefit from a public awareness campaign.”

The three-month trial requirement also turned out to be a major barrier to access since insurers, who lobbied for it, had no way of knowing which patients had complied.

The toolkit said states looking to pass a 12-month contraceptive access law should dispense with the three-month trial requirement. In Massachusetts, the toolkit said, the requirement should be modified to allow a healthcare provider to determine a patient’s eligibility.

The toolkit criticized Gov. Charlie Baker’s administration for failing to fix implementation problems with the law. “Governor Bakers’s office was happy to sign ACCESS into law and take credit for a reproductive rights victory. However, the governor’s office has been much more reluctant to take steps towards implementation of the law,” the toolkit said. “Bay State residents deserve more from the governor: they deserve someone who will help champion their rights.”