ALBANY — New York state on Monday warned health insurers they would lose state contracts if women on Medicaid are denied their choice of higher-cost, brand-name contraceptives unless cheaper, generic methods “fail first.”
The move comes after The Associated Press reported Monday that some New York Medicaid patients were told they had to switch to lower-cost contraceptives unless the cheaper measures failed, resulting in pregnancy, bleeding or nausea.
The conflict stems from an apparently unintended consequence of a cost-cutting measure in effect since October. That state measure sought to substitute a cheaper, generic birth control pill for contraceptives such as the monthly NuvaRing or weekly patch.
“If a health plan is not attentive to the needs of its patients, they will no longer be a contracted health plan with New York’s Medicaid program,” said James Introne, Gov. Andrew Cuomo’s deputy secretary for health. “If there is resulting patient discomfort with a health care plan or its policies, it is a situation that the state will remedy.”
Introne said that although he sees no “significant level of complaints,” it is critical for women to be comfortable with their birth control method.
“A woman’s ability to access birth control is a priority for New York’s Medicaid program,” Introne said.
Leslie Moran of the New York Health Plan Association, a statewide health insurance industry lobbying group, said companies are working to resolve disputes.
“Plans have worked with the state, and continue working with the Department of Health, to both assure access and to address any issues that might arise in a timely manner,” Moran said. “As previously indicated, all plans cover a variety of contraceptive methods — generics, brand name or both — because they are committed to ensuring women have access to this important coverage.”
The state, women’s health advocates and insurance companies had been working on the issue since shortly after Oct. 1 when the change took effect.
Contraceptives work best when women are comfortable with them, and a change can trigger adverse physical reactions, said M. Tracey Brooks, CEO of Family Planning Advocates in Albany. In addition, telling a woman she must stop using her weekly or monthly contraceptive and instead take a daily pill could lead to a greater chance of forgetting to take the daily dose, which must be done at the same time of day.
“Once again, Governor Cuomo has stood up for the women of New York State and has ensured that Medicaid meets their family planning needs,” Brooks said in a statement reacting to Introne’s announcement.
The state’s Medicaid cost-cutting effort, which has reduced billions of dollars in government costs for the federal-state health care program for the poor. Before the state undertook the effort, it had been spending as much as $53 billion annually on a program that was the most expensive and most generous in the nation in terms of optional services for its nearly 5 million residents on Medicaid.
One measure that took effect Oct. 1 required private insurers in the managed care program to use generic prescriptions whenever possible.
Not all participating private insurers cover the once-a-month NuvaRing or weekly patch contraceptives, which would leave some women who receive Medicaid unable to get those devices. Further, the insurers that do offer one or more of the newer contraceptives have denied the doctor-prescribed contraceptive under the directive.
Some women appealed the decision, which is allowed under the state regulations, although the state has no data on how many have done so.
“The system is working for millions of women, but it is an ongoing process,” said Moran of the New York Health Plan Association. “The plans, with the state, are constantly updating their policies.”