Birth control & self-pay patients

Like a lot of people who regularly follow health care policy and news, I spent part of yesterday digesting the U.S. Supreme Court’s ruling in Burwell v. Hobby Lobby, the case that determined that closely-held companies can opt-out of including some or all forms of birth control in their employee health plans if there is a religious objection on the part of the company’s owners.

Plenty of ink and many an electron will be used over the next few days arguing why the Supreme Court was right or wrong in its ruling, and what it does or does not mean for women, employers, religious liberty, and (of course) the next few election cycles. As a rule I try to avoid using this blog to share my views on policy and politics, and I’ll stick to that rule here.

That said, the ruling does mean that some women who do want birth control will now be self-pay patients when it comes to obtaining it. And that falls very much within the subject matter of this blog. So while others share their joy or outrage over the decision, I’ll move past that to try to offer some useful information on how women shopping for birth control can get the best deal as self-pay patients.

A quick note – I’m going to just stick with birth control pills, since it seems like that’s about 99% of the issue involved here. There are other forms of birth control as well, ranging from pretty cheap (condoms) to fairly expensive (intrauterine devices), but to keep things simple and to focus on what most people seem to be concerned with, I’m just going to stick with birth control pills.

Another quick note – I’m not endorsing the use of birth control, or suggesting it is or isn’t morally appropriate for some to use or not use. I have my views on the topic, but I’ll keep that to myself and just stick with what this blog is about, which is explaining to self-pay patients how they can obtain the medical services they want or need.

The first (and pretty much only) thing for people to understand is that shopping for birth control pills as a self-pay patient is no different than shopping for any other sort of prescription medicine as a self-pay patient. If you can shop for Xanax or Cambia, you can shop for birth control pills.

As a first stop when trying to find the best deals on prescription drugs, I suggest a site like GoodRx or WeRx.  These are online platforms that will show you the cash prices of retail pharmacies near you, which can vary substantially.

Consider Yaz, which seems to be one of the leading birth control pills on the market. According to GoodRx, prices for the brand name drug are fairly similar at local pharmacies in the Alexandria, Virginia area, between $88 and $92. But the generic versions (gianvi, vesture, lonyra) have a much broader range, between $31 (CVS) and $60 (Target).

There’s also Seasonale, and its generic versions jolessa, introvale, and quasense. The brand name is between $269 and $278 at local pharmacies (it’s for three months though, but that’s still pricey at about $90 a month), but prices for the generic versions are much less, between $60 and $70 for a three-month supply at Rite Aid, CVS, and Walgreens (so around $20 a month). Other local pharmacies have much higher prices, around $105 to $110 for three months’ worth of pills, which is why it pays to search around and compare prices.

If $20 or so a month still seems like it’s too much (or the products available at those prices aren’t suitable for some reason) there are even less expensive options. The generic aviane, for example, is $11 at Walgreens, $12 at CVS, and $13 at Rite Aid (all with coupon). Sprintec, another generic, is $9 for a month’s supply at Walmart and Target.

Walmart actually has nine different generic birth control pills available for $9 a month, according to their $4 generic drug list (apparently they can’t do it for $4?). Sprintec and what I’m guessing is a variant called tri-sprintec appear to be the only birth control pills offered by Target as part of their $4 generics program.

If in fact you really are looking for a $4 generic birth control pill, there are still options. Philith and gildagia, both generic versions of Ovcon, are available at Target as well as what GoodRx can only identify as a local membership warehouse (i.e. Costco, Sam’s Club, or BJ’s) for $3.77. Other local pharmacies including Safeway, Walmart, and CVS all carry the same pills for about $6 or $7.

Using GoodRx or WeRx, it should not be terribly difficult to find relatively low-cost options. Since I used my own zip code in a major metropolitan area to find these prices, I thought I’d also check on a few of these drugs availability using the zip code for the area I grew up along the Oregon coast, near Lincoln City. It’s not exactly the wilds of Wyoming, but it’s a fairly rural/small town area.

By and large, the results were fairly similar between the DC metro area and Lincoln City. According to GoodRx both philith and gildagia are available at the Fred Meyer pharmacy (that’s a major grocery chain in the west for those of you not familiar with it) for the same $3.77 price that Target offers it for where I currently live, and the other pharmacies in the area sell it for between $6 and $8. Aviane is a bit pricier, between $19 and $20 at the Lincoln City pharmacies compared to $11 – $13 in the DC area. Other birth control prices are similar as well.

Another option is mail-order prescriptions, something that may be a better option if you do live in the wilds of Wyoming. I went on the Health Warehouse site and found aviane for $20, sprintec for $9, and jolessa for $101 (about $34 for a month’s supply). For a branded product I found Yaz for $85, a little less than what it’s offered for at my local pharmacies.

Generics aren’t the right medication for everyone (although they probably are for most), and brand names can be a little pricey. But given the fairly widespread availability of birth control pills for $20 per month or less, it seems reasonable to think that most employed women who as a result of the Supreme Court’s Hobby Lobby ruling find themselves as self-pay patients for at least this area of their healthcare should have relatively little trouble finding something that fits their budget.

In fact, because of the way third-party payer healthcare tends to drive up costs (particularly for relatively inexpensive things, like birth control) it’s entirely possible that most women will actually save money on birth control simply by paying directly for it.

Ultimately a $20 or $90 per month bill for birth control that is supposedly paid for by an employer is going to be paid by employees through reduced wages or higher health insurance premiums, and the only thing that running it through the insurance system accomplishes is adding more costs to the process. Self-pay patients, of course, manage to avoid these bureaucratic costs.

In the end, however one feels about the Supreme Court’s ruling in this case, it may be a financial winner for working women who will now be able to save money by paying directly for their birth control.

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8 Responses to Birth control & self-pay patients

  1. Michael Scharf says:

    Unfortunately, the central premise of your article is incorrect. Oral birth control pills ARE NOT part of the Hobby Lobby decision. Of the 20 types of birth control mandated by the ACA, only 4 were at issue. And those 4 were drugs and devices (example Plan B) that prevent a fertilized egg from implanting and growing. Those forms that prevented fertilization (condoms and oral birth control as examples) are not at issue.

    So, while I agree that after almost 60 years, there is a good case to be made that oral birth control pills can be OTC, that was not the issue in this case. BTW, one of the drugs, “Plan B” is available over the counter.

    • says:

      The central premise of my blog post is that women can pay directly for their birth control at prices that most would find pretty reasonable and affordable. And it’s my understanding that ALL forms of birth control are covered by the Hobby Lobby decision – the fact that only four forms were specifically at issue in this case doesn’t change that. Any employer that is closely held can decide not to include any birth control as part of their health plan, assuming it’s ‘closely held.’ There’s sure to be more litigation on this subject, but the basic holding is fairly clear I think.

  2. Jerome Bigge says:

    On my blog I have pointed out many times that prescription laws are “part of the problem” making our health care costs as high as they are.

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  5. Rachael Merritt says:

    If you are low income ask your doc about RX programs. Some drug companies offer BC for cheap or for a deeply discounted price. We were on a plan that didn’t cover then many years ago, my doc presented this option. Online ordering was available, and it worked well.

  6. daniellopezz says:

    i agree with rachael merritt .

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