Birth control often not covered by Canadian insurers

Should birth control be covered by health insurance plans? In the United States, where certain religious employers’ plans are exempt from covering contraception, even though it is mandated under the Affordable Care Act (ACA), that question made it all the way to the Supreme Court. With no such legislation in Canada, insurance coverage for contraceptives is patchy and sometimes non-existent.

Provincial health insurance plans typically don’t cover most drugs and devices, except for certain groups, such as those who are poor or older, or people in health care facilities. Many Canadians get the cost of drugs covered through supplemental insurance from their employer. But unlike in the US, where almost all plans are now required to cover all available contraceptives — including barrier methods like diaphragms and sponges, hormonal methods like pills and rings, and implanted methods like intrauterine devices (IUDs) — in Canada, there are no such requirements.

Group plan offerings in Canada vary widely. Some are fairly comprehensive. The city of Toronto’s group plan, for instance, covers oral contraceptives, IUDs and diaphragms. Others, however, are less encompassing. Canada Post’s plan (Great-West Life) does not cover diaphragms and covers only some IUDs. The Public Service Health Care Plan, which provides coverage for federal government employees through Sun Life, states that it pays for no form of birth control other than oral contraceptives. (The same plan reimburses annual costs up to $500 for erectile dysfunction drugs, $300 for massage therapy and $300 for the services of a naturopath.)

A few plans, such as the one for employees of Save-on-Foods, a large western grocery store chain owned by Overwaitea Food Group, appear to exclude birth control altogether, according to a summary of its benefits package posted online. (The company’s employees are not covered by the benefits plan of their union, the Christian Labour Association of Canada, which offers generous contraceptive coverage, but instead get benefits through the United Food & Commercial Workers union.) Overwaitea Foods declined to comment.

Many employee insurers do not routinely cover the cost of birth control, such as intrauterine devices.

Image courtesy of areeya_ann/iStock

Employer-sponsored drug plans were first introduced in the 1960s, says Joan Weir, director of health and dental policy at the Canadian Life and Health Insurance Association, an industry trade group. To increase their competitiveness, companies began covering devices in the 1970s and 80s, such as prescription eyewear, orthotics and hearing aids. But contraceptive devices, like IUDs, rings and patches, have not been routinely added. It is at the discretion of the employer and its insurer to decide which drugs and devices to cover, she says.

Some employers commit to providing items that are “medically necessary for the treatment of sickness or injury.” Preventing pregnancy is neither. When covered, contraceptives are sometimes referred to as “preventives,” alongside items such as elective vaccines.

Some contraceptives, such as the Mirena IUD and the birth control pill, have medical uses outside preventing pregnancy — to control heavy bleeding, for instance. Dr. Monica Kidd, a family physician in Alberta, was “gobsmacked” when a patient requested the contraceptive pill, but said her insurance wouldn’t cover it unless it was for something medical. The patient requested that Kidd fudge why she needed it.

“It seems quite shocking to me,” said Kidd. “Pregnancy is a risk for some people.”

Weir confirms that employers have the right to make this distinction between treatment and prevention, and it usually involves a “prior approval” form signed by a physician to verify the condition exists. Canada Post’s plan outright excludes “contraceptive implants or appliances normally used for contraception whether or not prescribed for a medical reason,” according to its union.

“Insurers are taking a very narrow scope,” laments Dr. Wendy Norman, a physician at the University of British Columbia, whose focus is on family planning. The choice to not cover birth control is a bad one, she says, both for the company and for the woman. In North America, about 48% of pregnancies are unwanted, according to the International Federation of Gynecology and Obstetrics. Numerous studies, by the Guttmacher Institute and others, says Norman, have found that women with unplanned children are less likely to finish their education and less likely to advance in their careers.

Norman also thinks that covering only the birth control pill and excluding devices is wrong-headed. In the real world, she says, the pill has a failure rate of 9%, whereas so-called “set and forget” methods, like the IUD, have only a 1% failure rate. “It’s phenomenal that insurance plans cover these mid-effective methods but not highly effective methods,” she says.

“Maybe it’s time to revisit this,” says Weir. “Plans are not keeping up with the way treatment is delivered.” She notes that there hasn’t been much concern raised about lack of birth control coverage. “People need to make those wishes known.”

Canada is the only country in the world with universal health care, but no pharmacare, which is “outrageous,” says Colleen Flood, a health law professor at the University of Ottawa. “My hope is that we’ll bring some pharmaceuticals and devices into the public plan. We need a rational process.”

Pregnancy remains the world’s second biggest killer of reproductive-age women, according to the World Health Organization, resulting in the deaths of some 300 000 women each year.