UPDATE 1 Thanks to commenter MJ_Oregon who actually read the relevant portion of the law:
First, birth control medications will NOT become OTC in Oregon and all insurance coverage still applies. Drum didn’t bother to check the legislation for what it actually says. HB 2879 allows PHARMACISTS to prescribe birth control medications to women over 18 after they fill out a health questionnaire and are counseled by the pharmacist. There are other safeguards built into the language of the bill as well. AND Section 2 of the legislation contains this language: “(3) All state and federal laws governing insurance coverage of contraceptive drugs, devices, products and services shall apply to hormonal contraceptive patches and self administered oral hormonal contraceptives prescribed by a pharmacist under this section.”
Okay, this is just a massive expansion of the allowed prescriber universe without touching the prescribed vs. non-prescribed categorization of hormonal birth control. This is a net win for women with current insurance, and women who want birth control but can’t easily get to a prescribing doctor. Very different story.
My bad for not reading the source documentation.
Kevin Drum is commenting on a recent decision by Oregon to allow hormonal birth control to be sold over the counter:
I know there’s some disagreement about this among progressives these days, since prescription birth control is covered by Obamacare and OTC birth control isn’t. But I assume Oregonians who want a prescription can still get one, and allowing contraceptives to be sold OTC as well is the right thing to do. That decision should be made solely on safety grounds, not on grounds of political convenience. This is the same argument we make against things like forced ultrasounds for abortion patients, and it’s the right one
For people who are lucky enough to have access to decent insurance, this is a muddled win. For women without access to decent insurance, this is a significant improvement to the status quo.
It definately lowers the barriers to accessing birth control for some more women which is a win as they won’t have to see their ObGyn or PCP to get a prescription. However, if the drugs are being sold over the counter, most insurance companies won’t pay for over the counter medication of any sort. Further more, women can’t use their tax advantaged health savings dollars to spend on over the counter medication of any sort. Reimbursement for OTC medications only occur when their is a prescription. OTC medications will be more costly than zero cost-sharing birth control for women with health insurance. Once we start factoring in a prescription is needed for reimbursement, the cost barrier that reimbursement knocks down is replaced by accessing a provider to write the scrip.
The real winners of this policy would be women without health insurance, so that increasingly means immigrant women. Increased access to birth control for this group is a win.
The political downside is that putting hormonal birth control OTC gives anti-choice, anti-contraceptive politicians another angle of attack against including contraception as a core, Essential Health Benefit in any and all insurance policies as it is available over the counter. Senator Gardner (R-Co) used making birth control OTC as a dodge against all of his anti-contraception policy views in the last election. Getting a policy victory at the cost of a political club is the downside of the deal. But it is a policy victory that benefits marginal members of the community while not harming others.
The other part of the policy change that stretches a birth control prescription from once per quarter to one per year is a pure policy win on cost, effectiveness, barrier lowering and efficiency grounds.
Baud
Anything policy win that helps ordinary people will come with a political club attached to it. That’s especially true in the area of reproductive rights and women’s health.
sparrow
I’m confused about the health savings plans not paying for over-the-counter medicine, because I thought they were definitely allowed? I buy contact solution with mine, which hardly needs a prescription… I also remember that it covered crutches and all manner of medical devices which you wouldn’t need a prescription for. If this is an explicit recent change in the ACA, why?? It makes no sense.
Baud
@sparrow:
When I had an HSA pre-ACA, it did not cover OTC meds. Don’t know about crutches or devices as I thankfully never need them.
maurinsky
Pre-ACA, health savings plans allowed otc medicines, but that changed several years ago. I used to do a big shopping trip in December to stock up on naproxen, Nyquil, ibuprofen and other otc medical stuff – I would basically refill my first aid kit.
Richard Mayhew
@sparrow: medical devices that are otc are still hsa/fsa reimbursable but otc drugs are not. See the link in the post
Another Holocene Human
I look forward to the discussions of which birth control aligns best with your food allergies and sensitivities or if your blood is acid or base (don’t ask) on the woo woo boards.
kekekeke
opiejeanne
@Another Holocene Human: Oh dear Lord, I know of this woo from ex-in-laws of my middle kid. They believe your blood type determines what you should eat, as well as your personality. They thought they could tell her blood type by analyzing her personality, and were incorrect in their guess.
Another Holocene Human
@Richard Mayhew: I kind of understand why this was done but it does create a hardship for people.
The doctoring community is extremely jealous of that prescription pad power. In other countries, pharmD’s can write some prescriptions.
There are plenty of times a person might know exactly what their issue is and making an appointment with a healthcare provider is kind of a waste of everyone’s time … but those OTC medicines are getting more and more expensive.
(One example is yeast infections, providers don’t think a patient should have to see them for that after the first time and medicated treatment is available OTC. You read a lot about folk treatments, though, because it isn’t cheap.)
At the same time, some people are buying all sorts of counterproductive, dangerous, or fake formulations, and that includes corporate OTCs and also the DSHEA crapflood and the homeopathic crap and let’s not forget vitamin pills too. So I can see why the IRS would be all …. ehhhh, how about not.
opiejeanne
Richard, I’m not sure OTC BC is a win. Hasn’t BC required a prescription because of possible issues for the user?
Another Holocene Human
@opiejeanne: It doesn’t help that there are some medical conditions correlated to blood type which helps fuel all of this. (For example, Type O is more likely to get ulcers, although after I got mine I found out I was actually Type B (OB, I think). Lotta O in my family.)
I’ve seen that blood type = personality thing in East Asian culture quite a bit.
Another Holocene Human
@opiejeanne: The argument is that certain types of BC have history of use and side effects where they are no more harmful than other OTCs, then the argument was whether women were smart enough to use them properly. Some women’s rights advocates have been pushing for it because it is allowed overseas pretty routinely.
Aspirin can cause stomach bleeding. Tylenol can wreck your liver or kill you. Ibuprofen can wreck your liver fast combined with alcohol.
Omeprazole is sold OTC and they’re still not sure about long-term risks (although it suppresses your immune system so that’s fun–ask me how).
Benadryl can cause risk of accident, injury, or death if operating equipment or heavy machinery.
I could go on … (Lots of that stuff in the vitamin aisle can kill you)
Another Holocene Human
Pseudoephedrine could kill you. Probably not as fast as ephedra (which was sold in high, uncontrolled doses), but just read the package labeling sometime. Serious stimulant there.
opiejeanne
@Another Holocene Human: They’re Romanian. Came out of the country 37 years ago with one baby, two suitcases, and $50. Just being from Romania during the Ceaucescu (sp?) years would make one distrust doctors, I think, but they fall for every chunk of woo that comes their way, including rubbing DMSO on their skin, and self-diagnosing and self-treating conditions such as diabetes.
They use real doctors when they have an emergency and end up in a hospital, but ignore the docs’ advice when they are discharged.
opiejeanne
@Another Holocene Human: Yeah, I know about the dangers lurking in the pain-killer aisle.
I guess it’s because I’m old and still have some old ideas about doctors (despite my extreme annoyance with them at times for patriarchal behavior), and The Pill was pretty new when I started using it. so the whole idea of a doctor keeping a watchful eye is almost part of my DNA.
Emily68
@opiejeanne
They thought they could tell her blood type by analyzing her personality:
A combination of hematology and astrology.
PurpleGirl
@opiejeanne: I have a friend who lost an ovary to cancer when in her early 20s. The problem… her mother never told her that an aunt had died of ovarian cancer so when her doctor asked her about such disease in her family, she said “no, nothing that she knew about”. (I saw the same doctor, so I know how the doctor handled many problems.) The doctor put her on the pill and within a year she had developed the cancer and had to have surgery. Their discussion of BC would have been different and the doctor might have prescribed differently for her. (Luckily, she was able to retain one ovary because she did want to have children.)
artem1s
from
http://www.irs.gov/uac/Affordable-Care-Act:-Questions-and-Answers-on-Over-the-Counter-Medicines-and-Drugs
You can’t use your card with the pharmacist unless you have a script…
5. How does this change affect over-the-counter medical devices and supplies?
A. The new rule does not apply to items for medical care that are not medicines or drugs. Thus, equipment such as crutches, supplies such as bandages, and diagnostic devices such as blood sugar test kits will still qualify for reimbursement by a health FSA or HRA if purchased after Dec. 31, 2010, and a distribution from an HSA or Archer MSA for the cost of such items will still be tax-free, regardless of whether the items are purchased using a prescription
You can use your card for OTC medical items, some of them will still be pre-tax, some will not be considered pre-tax and the cost of those items will be added to your gross income. But certainly not the same as having to pay out of pocket.
11. The ACA removed over-the-counter medicines and drugs from the list of reimbursable qualified medical items if purchased without a prescription. If you have an HSA, Archer MSA, health FSA, or HRA, how will the change in the law affect reporting on Form W-2? Do the reimbursements for items that are not qualified medical expenses need to be included as taxable wages on employees’ Forms W-2?
A. If you have an HSA or an Archer MSA, distributions for expenses that are not qualifying medical expenses (including over-the-counter medicines and drugs purchased without a prescription) will be included in your gross income and subject to an additional tax of 20%. The income tax and additional tax are reported on Form 8889 for an HSA distribution and on Form 8853 for an Archer MSA distribution. You complete these forms and attach them to your Form 1040 when you file your income tax return. Distributions from an HSA or an Archer MSA are not included as taxable wages and do not affect your Form W-2.
Olivia
My experience with prescription meds becoming OTC is that it becomes a daunting expense if you are low income. The meds are often quite expensive and having them covered means you pay less with a co-pay. Medical Expense Accounts used to cover OTC items but that ended a few years ago. I doubt many low income people have Medical Expense Accounts anyway.
maurinsky
Since I am now in my late 40s, the pill has raised my blood pressure a bit – I’m still in the realm of normal, but the high end of normal, where I was always in the low end of normal before. I only have to go once a year to checked checked up, it’s part of my annual physical. I think there are some issues, though, with different formulations, and if its OTC, people will decide based on cost, not so much on which one works best for them. So I’m not 100% excited about this.
I would note that the cost of my allergy pills continues to rise ever since it went off script on on to the shelves. Even the generic stuff is expensive.
opiejeanne
@PurpleGirl: Terrible. Glad she retained one ovary.
opiejeanne
@maurinsky: The generic for Claritan just got WHOA! expensive when we checked the price at Target; it used to be pretty cheap. The big bottle we have now came from Costco and it was reasonable when we bought it.
Another Holocene Human
@Olivia: Depends who they work for. Sometimes it’s a tax dodge for the higher ups AND a way to offer insurance without having to pay much. If stuff comes out of hsa that is definitely a hardship for that person.
Ian
Don’t underestimate the effective cost of frequent doctor visits to get prescriptions, particularly for relatively poor but insured women. That visit and the things around it can easily soak up multiple hours of time, and time is either a) money or b) just not available at all. Having insurance pay for the visit and the pills is certainly good, but it doesn’t mean there’s “no cost” to having to go to a doctor every few months, schedule the appointment, drop off the prescription, wait or come back to pick it up, and so on.
I'mNotSureWhoIWantToBeYet
As others have mentioned, moving prescription drugs to OTC can be expensive and cause lots of annoyances even if it can improve access.
Thanks to my dad (who once claimed he was allergic to everything that was green and growing), I’m allergic to just about anything that makes pollen. Even after going through a several year long stretch of desensitizing shots, much of the spring and fall is like agony.
What works best for me is Allegra D. It used to be a prescription, now it’s kinda OTC.
Of course, since too many people were cooking decongestants for nefarious reasons, those of us who need them are treated like criminals (“Let me scan your license. Sign the form saying you know the penalties if you…”) to buy a 15 day supply at $1-2/pill that’s hidden behind the counter. When it was a prescription, these annoyances weren’t present and the cost was much less.
We need rational prescription rules for contraceptives and allergy medications. We need sensible child-proof cap and packaging rules, too. This medication regulation and delivery system is broken in too many ways….
Cheers,
Scott.
(Who isn’t holding his breath.)
Mj_Oregon
Oy. First, birth control medications will NOT become OTC in Oregon and all insurance coverage still applies. Drum didn’t bother to check the legislation for what it actually says. HB 2879 allows PHARMACISTS to prescribe birth control medications to women over 18 after they fill out a health questionnaire and are counseled by the pharmacist. There are other safeguards built into the language of the bill as well. AND Section 2 of the legislation contains this language: “(3) All state and federal laws governing insurance coverage of contraceptive drugs, devices, products and services shall apply to hormonal contraceptive patches and self administered oral hormonal contraceptives prescribed by a pharmacist under this section.”
Here’s the link to a PDF of the actual legislation: https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/HB2879
bobbo
Definitely.
Finite.
Definite.
Definitely.
I'mNotSureWhoIWantToBeYet
@Mj_Oregon: Thanks.
Cheers,
Scott.
sparrow
@Richard Mayhew: Good thing to know, because I was going on old information. I’m still confused as to why, though. Why shouldn’t people use their FSAs for tylenol?
Richard Mayhew
@sparrow: It was a way to get a positive CBO score for the entire package of legislation. Restricting HSA expenditures increased net tax revenue of the bill.
As for the policy logic, I think that HSA/FSA/HRAs were seen as a way to pay for a high deductible ($1,500 or more for instance) and paying for common over the counter treatments that would have been bought anyways with tax advantaged dollars is an inefficient subsidy to people who are doing reasonably well for themselves (you have to be doing Ok to get any tax advantage from an HSA). So paying for crutches was still in as that addressed an acute medical problem that probably tied to a prescription while paying for naprosyn was out as that probably was not tied to a prescription or other encounter with the medical system.
Mj_Oregon
Thank you, Richard, for updating your post.
Richard Mayhew
@Mj_Oregon: Thank you for giving me good information to correct an easily correctable fuck-up.
I like to get things right (except my spelling), and I prefer to do it the first time, but I’ll make sure it is right the second time.