Each fall, 24-year-old Jessica visits the Central District Health Department for an annual exam and to get affordable oral contraceptives. For the past six and a half years, Jessica, who prefers not to give her last name to protect her privacy, has received birth control from the publicly funded clinic at a considerably reduced rate. But recent price fluctuations in oral contraceptives distributed by pillmaker Ortho-McNeil Inc. don't lend assurance that Jessica will have access to the same birth control options in the future.
In the past, Ortho-McNeil provided birth control pills to publicly funded clinics at a vastly reduced rate, often for as little as one penny per pack. But with no notice last month, Ortho's pill prices for public health clinics skyrocketed.
"All of the sudden [Ortho-McNeil] raised the price of a pack to over $18," said Linda Knopp, program manager for Reproductive Health at the Central District Health Department. In some areas, prices went to as much as $21 per pack.
The sudden price hike made clinicians question whether they could afford to provide women the same range of options for reproductive health care and oral contraceptives that they have offered in the past.
"We certainly do not have the budget to handle the type of increase that was announced," said Knopp.
After some public outcry by clinics across the country, Ortho relented, and brought its prices back down.
In a statement made to online magazine Slate after the price hike, Ortho provided no specific reason for the increase, saying only that the supplier's products "are comparatively priced with other hormonal contraceptive options."
But the increases and decreases in birth control costs are making nurse practitioners and other clinicians at the Central District Health Department nervous. If birth control prices for publicly funded clinics continue to fluctuate, low-income women who rely on these clinics for reproductive care may feel the consequences.
As one of a handful of publicly funded clinics in the Treasure Valley, the Central District Health Department clinic in Boise operates on a tight budget. The agency saw over 6,600 women last year. About half of the women women who receive a form of birth control use oral contraceptives. The three Treasure Valley-area clinics that make up the Central District Health Department administered 14,630 packs of Ortho McNeill brand birth control pills last year.
Because the clinic receives some funds from a federal program called Title X, the clinic is eligible to receive major discounts on oral contraceptives and other forms of birth control from big suppliers. Although a special program under Title X determines a price cap for birth control, pricing confidentiality does not allow the public to know what that cap is. So it's anybody's guess when and if costs of oral contraceptives could go up again, and if those prices might render certain birth control options off limits to low income women.
The CDHD charges women and men for services and prescription based on income and ability to pay. About 50 percent of the women who receive services from the clinics pay nothing.
"Even though they're not paying, they may have limited access to certain options," Knopp said. Those women may have been forced to choose from a generic alternative, or select another form of birth control.
Lorraine Fortunati has worked as a nurse practitioner at the CDHD for 15 years. She said it's not as simple as just finding the cheapest pill available.
"Some women have certain conditions, or have certain side effects that make one pill choice better than another," Fortunati said.
Those women, Fortunati said, would be out of luck if the clinic wasn't able to provide the ideal pill.
Jessica, who pays a reduced rate for her reproductive care and prescription costs at the clinic, says she would not be able to absorb a monthly increase of $10 or more for her birth control pills. Jessica, who has worked in a geotechnical engineering lab for the past six years, relies on the affordable pills and services that the Boise clinic provides. Although she has taken Ortho Tri-Cyclen for eight years, she says she would switch to another pill if her costs increased.
"It's all I've ever used, and I'm comfortable with Ortho Tri-Cyclen, but I wouldn't stay with it if I could go cheaper on something else," she said.
The CDHD was on the brink of having to find other options for women when supplies of Ortho products were low last week. But, right when clinics were just about out of stock of the cheaper pills, Ortho-McNeil decided to lower its prices for public clinics. Ortho's oral contraceptives will not be as cheap for low-income women as they have been in the past--there will still be an average increase of about $3 per pack of pills--but at least those products will be accessible.
Knopp is relieved that Ortho-McNeil had a change of heart, but that doesn't make her confident that prices will not fluctuate again in the future.
"If they wanted to keep hiking the prices up until we couldn't afford it, then they could," said Knopp. If that were to occur, clinics would simply have to juggle or limit services to still be able to provide affordable care to low-income women.
"In many ways, we're dependent on [pill suppliers], so we want to be able to negotiate with them," she said.
Jessica wondered how many people might just walk away from the pill option.
"If people can't get pills for cheap then they're not going use them," Jessica said. "And then we're going to have a bunch of low-income people having babies, which ends up being way more expensive to society."
Fortunati hopes that pill suppliers will continue to provide cheap contraceptives because she believes that a wider range of birth control options help women make decisions that fit best with their goals. That's one of the reasons Fortunati works in a publicly funded clinic.
"Public health serves a purpose out there," she says. "And high prices do not help us serve that purpose."