In time for the new fiscal year, the North Dakota Public Employees Retirement System (NDPERS) Board of Trustees approved a change to the PPO/Basic Grandfathered Health Insurance Plan administered by Sanford Health. Prior to the change, the plan offered no coverage for prescribed hormone-based medications if used by a patient to prevent pregnancy (i.e., contraception or “birth control”). Meanwhile, patients who were prescribed these medications for other reasons -- such as the management of menstrual pain or excessive bleeding -- were forced to coordinate with their doctor to affirm (often repeatedly) to Sanford Health Plan staff that their medication was, indeed, for the health condition reported by the doctor.
In other words, patients were forced to engage in humiliating, labor-intensive self-advocacy just to be believed that they weren’t secretly using the meds for pregnancy-free sex! Some patients found the process so discouraging that they gave up on having their meds covered. I can say this with confidence because I’ve lived it, as have some friends and acquaintances.
Fortunately, the NDPERS Board finally changed its tune. Now, the updated Certificate of Insurance (COI) states, “3.5.3 COVERED TYPES OF PRESCRIPTIONS ... Generic oral contraceptives, Nuvaring, injections and/or devices will be subject to Member’s cost-share.” The prior caveats are gone. Patients who are prescribed these hormonal medications merely have a uniform, modest co-pay. Further, patients, doctors, and Sanford Health Plan staff will no longer spend their time verifying (and re-verifying) patients’ eligibility for coverage for these meds.
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You may be wondering how, given the Affordable Care Act, the NDPERS Sanford Health Plan doesn’t fully cover contraception (which would require no patient co-pay at all). That’s because “grandfathered” plans are not subject to the requirement of full coverage for prescribed contraceptives.
Interestingly, the rationale behind the change in coverage for hormonal contraception is that it’s simply better business for Sanford. The change also has no negative financial impact for the state or insured workers and their dependents. The folks at Sanford Health Plan realized it was more costly for staff to spend so much time looking for reasons to deny coverage than it was to simply cover these meds as prescribed with no fuss. As a result, Sanford informed the NDPERS Board that it favored a commonsense change. In turn, NDPERS trustees embraced the change as recommended by Sanford.
While this change in contraceptive coverage is a good one, let’s take a moment to acknowledge how inappropriate the old rules really were. Ultimately, pregnancy is a health issue. How can it not be? Pregnancy greatly impacts health needs. Pregnancy is physically and mentally arduous. Pregnancy is often even dangerous! Clearly, avoiding pregnancy is a health decision. If a doctor prescribes medication so a patient can avoid pregnancy, that is simply run-of-the-mill health care. The prior lack of coverage for such a basic kind of care was absurd, and it reeked of sexism.
The excessive bureaucracy created by the sexist prior policy was miserable for patients. Sadly, that fact wasn’t enough to get these medications easily covered for all who need them. Apparently, the change was only acceptable when it was clearly also bad business.
Good riddance to the prior policy of humiliation and scrutiny for patients. Welcome to the 21st century, where it is obvious that contraception is health care and that insurance coverage for it is better business for us all. If you are a patient with the grandfathered NDPERS Sanford Health Plan who was previously nudged out of contraception coverage, you may now wish to revisit the option with your doctor.
Ellie Shockley is a political psychologist, social scientist and education researcher. This column represents her personal views and not the views of any organization. She completed a doctorate at the University of Chicago and postdoctorate at Nebraska. She lives in Mandan. Find her past columns at EllieShockley.com