November 22, 2013 — A majority of women are unaware that rules issued under the Affordable Care Act (PL 111-148) require most health plans to cover birth control without out-of-pocket costs, according to a series of surveys by Phoenix Marketing International, CNBC reports (Mangan, CNBC, 11/20).
The rules have spurred lawsuits from employers that object to offering the coverage to their workers. Although most employers are required to comply, houses of worship are exempt from the requirement, and religiously affiliated not-for-profits are eligible for an accommodation that ensures they do not have to pay for or directly provide the coverage to their employees. Private companies are not eligible for an exemption or accommodation (Women's Health Policy Report, 11/19).
To track women's awareness of the rules, Phoenix conducted three separate surveys throughout 2013, each questioning more than 3,000 women ages 18 to 45.
The first survey, conducted in the first quarter of 2013, found that 44% of women knew that contraceptives would be available without copayments. In the second quarter, 45% were aware of the option, a statistically insignificant increase from the first survey.
Awareness rose to 48% in the third quarter of 2013. Kristen McNeill, senior project director at Phoenix, said the number likely increased because the contraceptive coverage requirement "has been around a while." She noted that overall awareness is still "relatively low."
The survey showed women are hearing about the benefit primarily from the Internet, friends and family members, and doctors and pharmacists, McNeill said.
Of the 48% who knew about the coverage in the third quarter, the survey found that 67% knew that generic oral contraceptives are covered, 40% were aware that brand-name oral contraceptives are covered and just 24% knew that non-hormonal IUDs are covered.
Little Marketing, But Supreme Court Case Could Raise Awareness
Although contraceptive coverage without out-of-pocket costs likely could increase the sale of the products, few pharmaceutical companies have promoted the benefit.
McNeill said Phoenix found that just two brand-name products -- Essure and Mirena, both sold by Bayer -- ran ads promoting the coverage.
A spokesperson for Merck said the company is not running any ads about the benefit but has "started to roll out more patient educational material through physicians' offices."
An executive at a different pharmaceutical company reasoned that some manufacturers would not find advertising campaigns to be cost-effective, noting that birth control is a relatively small part of his company's total business.
Meanwhile, Elizabeth Wydra, chief counsel of the Constitutional Accountability Center, suggested that the likelihood of a Supreme Court case surrounding the issue could help raise awareness (CNBC, 11/20).