VERMONT - When Vermont's colleges and universities seek the federal government's help in growing their student bodies, this probably isn't the kind of "growth" they're expecting. Tens of thousands of health clinics nationwide, including some student health centers on Vermont college campuses, have experienced a dramatic rise in the cost of birth control pills and other female contraceptives. The price hikes are the direct result of changes in the Medicaid rebate program included in the 2005 Deficit Reduction Act, which took effect January 1.
As a result, many female college students have seen the cost of their oral contraceptives rise as much as tenfold, while other birth control methods have been discontinued on some campuses due to the cost hike. Clinic directors and women's health advocates warn that the recent price spike could lead to more women using the "morning-after pill," a less effective method of birth control, and perhaps even to more unwanted pregnancies on college campuses.
Miriam Simon, a physician's assistant at Lyndon State College in Lyndonville, reports that the price of Ortho-Tricyclen Lo birth control pills offered by her student health center jumped from $400 per case to $4000. That's caused the wholesale price of a monthly dose of the pill to go from $2.70 to $27.70. In the past, Lyndon sold students the monthly pack for $5, and used the profits to subsidize screenings for sexually transmitted diseases.
Currently, Ortho-Tricyclen Lo retails in Vermont drug stores for about $40 to $50 per pack. Simon says she's called local pharmacists looking for cheaper, generic alternatives, but has been unable to find one that retails for less than $20.
"A lot of these kids don't have cars, and Planned Parenthood is about 10 miles away from here," she says. "So I think there's definitely an access issue here."
Simon also points out that some of her students take the pill for reasons other than contraception, such as controlling irregular periods or treating polycystic ovaries. In total, she estimates that about 50 women on campus are affected by the recent price increase.
Gloria Vanderham, a spokesperson for Ortho Women's Health and Urology, maker of Ortho-Tricyclen Lo, explains her company had no choice but to charge student health centers higher prices. She says the Deficit Reduction Act, which was championed by GOP members and the Bush administration, limited the number of institutions and nonprofit health centers that qualify as "safety-net providers." Vanderham would not disclose the discounted price of the drug.
Rebecca Hill, director of health services at Johnson State College, has experienced a similar problem as have those at Lyndon State. She says her student health center has switched to a lower-priced generic pill in an effort to keep prices affordable for students. Nevertheless, students have seen the cost of the pill go from $5 to $15 per month. "Going from $5 to $15 in a student body that doesn't have extra resources has had an impact," she adds.
Moreover, Hill says the center has stopped carrying the NuvaRing. "The Ring," as it's commonly known, is a flexible plastic contraceptive inserted into the vagina that slowly releases doses of estrogen and progestin, the same hormones as in the pill. It's a popular method of birth control among college students because it doesn't require taking a pill every day, and it lasts for 21 days.
According to Hill, the Ring, which sold for $5 last year, would have increased to as much as $35. "We would have spent several thousand dollars to get it in here," she says. "That's meant that some women have had to change back to the pill when they'd rather be on the Ring."
Hill says many students must now find a way to the pharmacy in Morrisville - about 10 miles from campus - to purchase their birth control. And, on a campus where many students come from families with limited or no health insurance, even a $10 per month cost increase is significant. Hill estimates that about 100 Johnson State students are being affected.
Vermont's college health insurance plan, used by many students across the state, only covers $250 in prescription drug costs per year - less than the new annual cost of the Ring or Ortho-Tricyclen Lo.
Birth control pills are still the most common form of contraception used on U.S. college campuses. According to a 2006 survey of 95,000 students conducted by the American College Health Association, 38 percent of sexually active students rely on the pill, compared to 37 percent who use condoms and 2.5 percent who used spermicide. Interestingly, 14 percent cited "withdrawal" as their preferred form of birth control.
Colleges and universities aren't the only ones feeling the pain. Nationally, about one in four Planned Parenthood clinics, which often serve low-income, rural or inner-city clients, have also seen their birth control prices go up, eating into and sometimes even eliminating what little profits they made on them. According to Emily Blistein from Planned Parenthood of Northern New England, Vermont has not been affected. But in other communities around the country, she says the impact has been "devastating."
The higher price for birth control was reportedly an inadvertent consequence of the 2005 Deficit Reduction Act, but recent efforts in Congress to fix the error and reinstitute the cheaper pricing have all run into roadblocks. The first attempt was through the recent Iraq war funding bill; the second through a FDA reauthorization bill.
Vermont's congressional delegation is aware of the problem. Rep. Peter Welch was one of 93 members of Congress to sign a letter to House Speaker Nancy Pelosi (D-Calif.) asking that the old pricing structure be reinstated. But some Washington insiders predict that a solution probably won't be in place before the end of the year.
In the meantime, Hill at Johnson State has a suggestion for female patients who are having trouble paying for birth control pills: Ask your partners to share the cost.