House passes proposal to increase access to long-acting birth control, save Missouri money

The state House has again voted for a measure aimed at increasing women’s access to birth control while saving the state money.

Representative Shamed Dogan (photo; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 1499 would let health care providers use a long-acting reversible contraceptive (LARC) for a patient other than the one to whom it was initially prescribed.

When a woman in Missouri chooses to have a LARC implanted her doctor must order that device and the woman must return for another office visit to have it implanted.  If the woman changes her mind before the second visit and doesn’t want the device, Missouri law doesn’t allow it to be used for another patient.  It must be returned to its manufacturer and often it is destroyed.

The sponsor of HB 1499, Representative Shamed Dogan (R-Ballwin), said because Medicaid pays for those devices, the passage of his bill would save the state money.

“The State of Missouri currently wastes hundreds of thousands of dollars every year as well as very expensive devices every year, and this bill will allow those devices to be reassigned which will save taxpayer money and will help to save women time and money with extra doctor’s visits,” said Dogan.

Dogan said in Fiscal Year 2017 about 1,800 LARCs were “abandoned” by patients in Missouri.  About 1,000 of those could have been used for other patients and that would’ve saved Missouri about $220-thousand.

The proposal has been sent to the Senate 133-10.  Last year it was passed as an amendment to other legislation, but was not passed in the Senate.

Earlier story:  

Backers say bill to allow reassignment of birth control devices would save money, increase access

Backers say bill to allow reassignment of birth control devices would save money, increase access

Proponents say a bill in the Missouri House would expand access to birth control and save the state hundreds of thousands of dollars a year.

Representative Shamed Dogan (photo; Tim Bommel, Missouri House Communications)

House Bill 1499 would allow health care providers to use a long-acting contraceptive device for a patient other than the one for whom it was initially prescribed.

In Missouri when a woman goes to a health care provider and elects to use a long-acting reversible contraceptive (LARC), her provider must order that device and implant it on a subsequent office visit.  Often women don’t return to have the device implanted, and Missouri law doesn’t allow that device to be used by another patient – it must be returned to its manufacturer and is often destroyed.

In Fiscal Year 2017 approximately 1,800 LARCs were so “abandoned” in Missouri.  About 1,100 of those could have been used in other patients, saving the state approximately $220-thousand dollars.

Executive Director of NARAL Pro-Choice Missouri, Alison Dreith, told the House Committee on Health and Mental Health Policy, “By redistributing the device two things can happen.  Money is saved.  LARC devices are very expensive and this allows for the product to be utilized which overall saves the state money; and due to having stock on their shelves that can be used for another MO Health Net patient, providers are able to insert the IUD or implant that same day rather than having to wait for the person to return.”

Bill sponsor Representative Shamed Dogan (R-Ballwin) said the issue is one of fiscal responsibility.

“We’re wasting hundreds of thousands of dollars on pretty expensive birth control devices when in any other case with a pharmacy, with a product that someone orders and they don’t pick it up, you can reassign that to another patient,” said Dogan.  “This bill just allows MOHealthNet to do that with these devices and it has the potential savings to the state of a quarter of a million dollars a year.”

The proposal was passed out of the House in 2017 as an amendment to other legislation but did not become law.  No one testified in opposition to it in the Committee’s hearing.

The committee has not voted on HB 1499.

Republican plan would allow pharmacists to prescribe birth control pills

The sponsor of legislation that would allow pharmacists to prescribe birth control pills says his bill is both pro-choice and pro-life.

Representative Shamed Dogan (photo; Tim Bommel, Missouri House Communications)
Representative Shamed Dogan (photo; Tim Bommel, Missouri House Communications)

It’s pro-choice in the sense that we are trying to give women more control over their reproductive health and over their family planning, and it’s pro-life in the sense that the bill is intended to reduce unintended pregnancies and abortions,” said Ballwin Republican Shamed Dogan.

He said House Bill 233 could help reduce Missouri’s unplanned pregnancy rate by as much as 25-percent.

HB 233 would let pharmacists prescribe oral contraceptives to those 18 or older regardless of whether that person has a previous prescription.  Those younger than 18 who have evidence of a previous prescription could also be prescribed the pill by a pharmacist.

The legislation is projected to save Missouri money, and Dogan said it would save women money and time by negating the need for some visits to their doctor.

Several groups testified in favor of the bill, including the Teen Pregnancy and Prevention Partnership.  Its Executive Director Meg Boyko said HB 233, “would just be one step in the right direction to lowering barriers to access to care to those teens so they can take responsibility of their health and their health outcomes and prevent teen pregnancy.”

Representative Cora Faith Walker (D-Ferguson) said a similar plan in California didn’t have the results backers hoped it would.

“This is just a different barrier.  By making it behind the counter, making it a requirement for pharmacists to write the prescription, it just kind of shifts the barrier,” said Walker.

“We’re a different state than California,” Dogan responded.  “I think one of the issues that we might have that they don’t face nearly as much is rural folks … I think the fact that many people in rural areas don’t have access to a doctor in the same way that they have a lot more pharmacists in their areas … Yeah there’s still somewhat of a barrier, but it’s not nearly what the barrier is right now.”

Dogan said he favors making birth control over-the-counter, but noted such proposals have not been adopted in states that are more politically progressive than Missouri, and he doesn’t feel such a bill would be likely to pass in the Missouri legislature.

Shannon Cooper testified against HB 233 on behalf of Blue Cross/Blue Shield and the Missouri Coalition.  He said their primary concern was that without the need for a prescription, women would make fewer visits to their doctors.

“Under the [Affordable Care Act] and insurance policies, we provide a free exam once a year and we feel like for a lot of the invincibles that we talk about who don’t think they’re ever going to be ill or have any problems, when they receive these birth control pills and the prescriptions that does drive them back to the physician to get that exam,” said Cooper.  “I think we all know that early detection of any type of disease is one of the best cures for that disease.”

Cooper also expressed concern that HB 233 would allow up to a 12-month supply of birth control pills to be prescribed under certain circumstances.

“We feel like there will be certain individuals who could take advantage, get that supply and then drop off our policies with that 12-month supply,” said Cooper.  “Obviously there’s a cost concern there.”

Others expressed concern that allowing a 12-month supply could lead to wasted pills, such as in cases in which a woman only uses them for a while and then stops for some reason.

Representative Mike Stephens (R-Bolivar), himself a pharmacist, said he hopes the proposal represents a larger effort to expand the availability of medical services.

“If there is a saving grace to the health care system it must include a greatly expanded role in health care delivery and health care access by a wide variety of health care professionals,” said Stephens.

The committee has not voted on HB 233.

Last year similar legislation was passed by the House 97-50, but stalled in the state Senate.