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US judge condemns health plan for not covering contraception

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7301.1507 (Published 23 June 2001) Cite this as: BMJ 2001;322:1507
  1. Deborah Josefson
  1. San Francisco

    A health insurance plan offering cover for prescription drugs but not for contraceptives is guilty of sex discrimination and violation of the 1964 Civil Rights Act and the 1978 Pregnancy Discrimination Act, a federal judge in Seattle, Washington, has ruled.

    The ruling marks the first time that a federal court has ordered a self insured health care plan offered by a small business to provide contraceptive cover to its female employees. The verdict has been hailed as a landmark decision and may lead to wider prescription drug coverage for contraception.

    US District Court judge Robert Lasnik issued his verdict in the class action lawsuit brought by Jennifer Erickson, a 27 year old pharmacist and drugstore manager.

    Ms Erickson argued that her employer, Bartell Drugs, discriminated against its female employees by not including cover for contraception in their prescription drug plans.

    Bartell Drugs is a family owned drugstore chain with 48 stores in Seattle. Most of its employees are women. Judge Lasnik agreed that the plan was discriminatory as prescriptions for all men's needs were covered, but contraception, a basic need for many women, went uncovered.

    In his decision, Judge Lasnik wrote: “Although the plan covers almost all drugs and devices used by men, the exclusion of prescription contraceptives creates a gaping hole in the coverage offered to female employees, leaving a fundamental and immediate health care need uncovered.

    “Male and female employees have different sex based disability and healthcare needs, and the law is no longer blind to the fact that only women can get pregnant, bear children, or use prescription contraceptives.”

    Women's groups have been lobbying for years for insurance cover for birth control.

    The matter became even more heated when sildenafil (Viagra), the new treatment for male erectile dysfunction, was introduced in the United States in 1998. Within two months of its introduction, half of all prescription insurance coverage plans agreed to pay out for sildenafil.

    Women of reproductive age spend on average 68% more on “out of pocket” health care than men of the same age, and this excess is mainly related to reproductive care and contraception. Oral contraception costs an average of $350 (£250) a year.

    Cover for contraception varies widely. Although most employment related insurance policies have prescription drug plans, many of these plans, like that of Bartell Drugs, fail to cover contraceptive drugs and devices.

    According to the American Association of University Women, half of all traditional “fee for service” plans fail to cover “reversible” contraception, such as contraceptive devices and oral contraception. Such plans do, however, cover female sterilisation with tubal ligation.

    However, 87% of health maintenance organisations cover contraceptives.