While the issue of over-the-counter access to EC is not yet resolved, health advocates can work to ensure that EC is available under the Medicaid program. Here are some questions to ask the State Medicaid agency and local Medicaid managed care plans:
- Is Plan B (produced by Barr Laboratories) covered by Medicaid? If not,why not?
- If Plan B is covered, is prior authorization necessary?
- Is Plan B available through prior authorization if not otherwise covered? How is prior authorization implemented when it is necessary to take Plan B within 72 hours of unprotected sex in order to be effective in preventing pregnancy? Can a pharmacist dispense a 72-hour emergency supply?
- If the state has a drug formulary, is Plan B on the formulary? If not, why not?
- If Plan B is not on the formulary, how is it made available in a timely manner (see question regarding prior authorization and72-hour supply)?
In preparation for potential EC over-the-counter (OTC) access, advocates also should look at how their state Medicaid program covers other OTC drugs and discuss with their state Medicaid agency and Medicaid managed care plans how low-income women will be able to obtain EC without a doctors prescription. Also discuss the procedures that will be used to allow teens ages 16 and under access to EC with a prescription.
See Emergency Contraception & Medicaid: A State-by-State Analysis and Advocates Toolkit from the NARAL Pro-Choice New York Insitute for Reproductive Health Access, the National Latina Institute for Reproductive Health, and the National Health Law Program on Medicaid and Emergency Contraception.
From the Health Advocate, newsletter of the National Health Law Program, No. 220, Spring 2005.
