Managed Care Inconsistent in Its Contraceptives Plans

By Muirhead, Greg | Drug Topics, October 23, 1995 | Go to article overview

Managed Care Inconsistent in Its Contraceptives Plans


Muirhead, Greg, Drug Topics


Although about 90% of all health maintenance organizations now provide some form of coverage of "reversible" contraceptives for their patients' use, practically speaking, that coverage varies widely from HMO to HMO.

That was the word from Jacqueline Koenig, a researcher at Princeton University's Office of Population Research. She spoke recently at a conference on women's health issues, sponsored by Wyeth-Ayerst Laboratories and held at the company's Princeton, N.J.-based research facility. She noted that while some plans cover contraceptives as a regular part of their drug benefit, others may argue that contraceptives are not medically necessary.

Koenig pointed out that while some HMOs cover contraceptives only if physicians say they are "medically necessary" for their patient's use, others readily cover the full range of contraceptives other than the use of condoms--which no HMO is known to cover.

In particular, she contrasted the following four HMOs' coverage of contraceptives and noted that patient pressure has proven effective in changing HMOs' coverage policies at one of them:

* At Care Choices, a 150,000-member independent practice association (IPA) model HMO based in Farmington Hills, Mich., contraceptives are covered only when they are deemed medically necessary. The HMO does not consider the prevention of pregnancy alone to be a medical necessity.

* Community Health Plan, a 263,000-member staff- and network-model HMO based in Latham, N.

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