Campus Birth Control Expenditures Increase

In health centers at hundreds of colleges and universities around the country, young women are paying sharply higher prices for prescription contraceptives because of a change in federal law.

The increases have meant that some students using popular birth control pills and other products are paying three and four times as much as they did several months ago. The higher prices have also affected about 400 community health centers nationwide used by poor women.

The change is due to a provision in a federal law that ended a practice by which drug manufacturers provided prescription contraception to the health centers at deeply discounted rates. The centers then passed along the savings to students and others.

Some Democratic lawmakers in Washington are pressing for new legislation by year’s end that would reverse the provision, which they say was inadvertently included in a law intended to reduce Medicaid abuse. In the meantime, health care and reproductive rights advocates are warning that some young women are no longer receiving the contraception they did in the past.

Some college clinics have reported sudden drops in the numbers of contraceptives sold; students have reported switching to less expensive contraceptives or considering alternatives like the so-called morning-after pill; and some clinics, including one at Bowdoin College in Brunswick, Me., have stopped stocking some prescription contraceptives, saying they are too expensive.

“The potential is that women will stop taking it, and whether or not you can pay for it, that doesn’t mean that you’ll stop having sex,” said Katie Ryan, a senior at the University of North Dakota in Grand Forks, who said that the monthly cost of her Ortho Tri-Cyclen Lo, a popular birth control pill, recently jumped to nearly $50 from $12.

Ms. Ryan, 22, said she had considered switching to another contraceptive to save money, but was unsure which one to pick. She has ended up paying the higher price, but said she was concerned about her budget.

“I do less because of this — less shopping, less going out to eat,” said Ms. Ryan, who has helped organize efforts to educate others on campus about the price jump. “For students, this is very, very expensive.”

Not everyone is troubled by the price increases. Some people said they wondered why college students, many of whom manage to afford daily doses of coffee from Starbucks and downloads from iTunes, should have been given such discounted birth control to begin with, and why drug companies should be granted such a captive audience of students. Others said low-priced, easy-to-attain contraception might encourage a false sense of security about sex.

“From our perspective, this does bring to light a public health concern, but for a different reason,” said Kimberly Martinez, the executive director of the Abstinence Clearinghouse, which advocates abstinence from sex until marriage. “These young women are relying on this contraception to protect them. But contraception isn’t 100 percent — for pregnancy or for disease.”

The price change came as part of the tangled method by which drug manufacturers pay rebates to states for prescription drugs covered by Medicaid, the federal drug program for low-income people. Those rebates are set by calculations that take into account the lowest prices paid for certain drugs. Since 1990, the steeply discounted contraception given to university health centers and low-income clinics was considered exempt from those calculations.

The arrangement helped those who could least afford the contraceptives to receive them, but was also seen as potentially beneficial to drug companies, which might not make money on the college clinic sales but were able to market their products to young women who might grow accustomed to one brand over another.

More recently though, legislators, worried about abuse in the rebate calculations, set strict limits about which facilities would be exempt. Student health centers, among others, were left out — an unintended oversight, some lawmakers now say.

The new rules, part of the Deficit Reduction Act of 2005, came into effect at the start of this year, prompting pharmaceutical manufacturers to tell college clinics that they could no longer afford the huge discounts. Knowing that the change was coming, many health clinics stocked up on the discounted prescriptions and were able to offer cheaper contraception for months, into the summer and even the fall.

Then prices began skyrocketing.

“What happened here is what happened everywhere: The price went up,” said Jeanne Galatzer-Levy of the University of Illinois at Chicago. “We are a state institution, so we’re not in a position to do something different.”

At the University of Montana, the price of a NuvaRing, another birth control method, rose to $36 from $18, said Allyson Hagen, the state director of Naral Pro-Choice America. “This is a state school where people are on Pell grants and don’t have huge amounts of spending money,” Ms. Hagen said. “For them this is like a choice — groceries or birth control.”

Some types of prescription birth control have generic alternatives, which can be significantly less expensive than their counterparts. But even some generics are not as inexpensive as the discounted contraceptives had been at student health centers, experts said. And other types of contraceptives have no generic option.

In a 2006 study, 39 percent of undergraduate women said they relied on oral contraceptives to prevent pregnancy, said Mary Hoban of the American College Health Association. But no one can be sure how many of the more than three million women on college campuses nationwide who are estimated to use such contraceptives have been affected by the price increases.

College health centers have handled the circumstances in a variety of ways. Some colleges, too, say they were mainly unaffected by the change because students were covered by their parents’ insurance plans or their own insurance policies.

In Washington, lawmakers have introduced a proposal that would reverse the price increase, allowing an exemption so that drug companies would once again not be required to include sharply discounted contraception for university clinics in their Medicaid rebate calculations.

“This is such a mainstream issue,” said Cecile Richards, the president of the Planned Parenthood Federation of America. “This is clearly an issue with wide bipartisan support.”

Still, there were signs that some lawmakers might not want to be seen as supporting the provision, leading to the possibility that it would be attached to some other legislation sometime before year’s end.

Representative Joseph Crowley, a Democrat from New York who introduced a bill on the matter, said the change would require no taxpayers’ money to subsidize contraception. The drug manufacturers would pay for any discounts, but would not be required to pay larger Medicaid rebates because of those discounts.

“We’re not promoting promiscuity, but we’re also cognizant that people live,” said Mr. Crowley, who is among the lawmakers who say the change that took discounts away from university clinics was inadvertent. “We’re talking about adults, responsible adults who want to do the responsible thing.”