So you think your birth control is free now, thanks to the Affordable Care Act? Better double-check that with your insurance company.
In late July I received a letter from Blue Cross saying our coverage would change as of August 1st, including "Designated prescription contraception drugs." Hmm, "designated," I thought to myself. That sounds like a loophole. I better check it out. So I called Blue Cross to ask and they told me they wouldn't know until August 1st. So I said I would call back at that time, and called my mail-order pharmacy to ask them to hold any prescriptions that were pending until I called to approve them.
August 1st rolled around and I called Blue Cross again. The representative told me my specific oral contraceptive was covered. Yay, I thought.
My mail-order pharmacy robo-called to tell me I would be having an order filled on August 2nd, which I thought was odd, but hey, it would be free, so no harm no foul.
This morning I checked my bank account and my credit card had been charged. I called Prime and they told me that the information they had from Blue Cross said they would not be covering that type of birth control. They also said the order went through because somehow my doctor put in another prescription after I requested they not fill any prescriptions until I call, and somehow that superseded my request.
The pharmacy is refunding my money this one time.
I called Blue Cross to see what happened. This rep said the note in my file just said "advised on oral contraceptives" which is not useful. She told me that only certain types of oral contraceptives were covered at 100% under the ACA (as I'd suspected based on the wording) and that mine was not one of them. (Given that it is the generic for Ortho-Cyclen I find that pretty shocking.) I asked if there was a list of the covered birth control that could be found on their website or if she could email me one. She said no, she could read them to me over the phone. I asked how I would find out the information if it changes. She didn't have an answer for that so now not only do I have to switch birth control, I know I will now have to call in before every prescription refill to make sure that whatever I switch to is still covered.
She did make the lovely point that even the ones not covered at 100% would still be available at the standard prescription rate with my insurance. Apparently she hadn't looked at what kind of policy I have because I pay 100% of prescription drugs up through my deductible, which with my standard medications I will never hit in a year. I pointed that out and she said "oh." Because that is the only private insurance I could afford as a student and now as someone who is still seeking employment.
I also asked who sets the list of designated oral contraceptives. She said she could put me on hold to try to find out if I wanted. I said "please do." She did and came back and said the federal government set the list. I find that interesting and have no idea how to verify whether or not that is true.
Between the pharmacy and Blue Cross this took well over an hour on the phone. It is just good that I am damn persistent, by which I mean stubborn as a mule. But please do verify that your prescription is covered by your insurance before you order it again.
Here is the list I was given. If anyone else wants to call their health insurance company and see if they have a list and if the list matches up I would be very interested. Specifically to see if anything on this list is NOT on their list. Insurance companies can easily offer more (and would be wise to do so, in my opinion) but, if the list is truly mandated by federal law, could presumably not NOT include any of these.
- Camila
- Errin
- Heather
- Introvale
- Jolessa
- Jolivette
- Nora-BE
- Norethindrone
- Norgestimate/Ethinyl/ Estriadiol
- Quasense
- Trinessa
- Tri-previfem
- Tri-sprintec
(Interestingly these last two are generics for Ortho-tri-cyclen, which is like Ortho-cyclen [the one whose generics are not covered] except it includes a smaller amount of hormone in each succeeding week. I had been on this but my doctor switched me for medical reasons. Given that I don't think any of the ones above are anything like the one I'm on now, and I'm loathe to switch to something completely untried, I will probably have to switch back. Great.)
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