Why do I have to pay to replace my birth control when I have insurance?


Q: I lost my birth control 2 weeks before the end of last quarter.  The Student Health pharmacy told me that I’d have to pay $60 for a replacement or else wait until the start of this quarter.  I can’t afford that – don’t you have a back-up policy for prescriptions, considering birth control is basic health care?

A: While I’m sorry this happened to you, I’m glad you asked this question – it will give us a chance to discuss some important stuff about the health care system.

Technically speaking, this is actually not a Student Health Services issue.  While we prescribe the medication, and our pharmacy dispenses the medication, it is actually the Student Health Insurance office that determines what you have to pay.  You should contact them if you have questions or concerns about your coverage.

But your situation touches on some really big questions that everybody in Washington has been arguing about for years.  Is basic health care a right?  What is “basic” health care?  Who should pay for it?  How much are we all personally responsible for the cost of maintaining our own health? 

If we assume that basic health care is a right, what specific benefits should be included?  In a health care system with finite financial resources, should certain birth control medications be covered when there are far less expensive options available?  Medicines are like any other consumer product; they cost money to produce and the organizations who produce them need to cover their costs and meet a budget – just like doctor’s offices, pharmacies, labs (and universities).  Some medicines are more expensive than others, and doctors and patients and insurance plans have to take that into account when choosing which ones to use.

I think a lot of your frustration comes from the fact that even though you pay for your insurance every quarter, you have no idea what you’re actually getting.  What does a doctor’s visit actually cost?  What does that medication actually cost?  Who knows!?  It depends!  Different insurance plans pay different amounts for the same service – and there are literally thousands of different plans – so even your health care provider doesn’t know what things cost.  

As part of your education here at THE Ohio State University, we want to teach you how to be a knowledgeable health care consumer and as you discovered, those lessons can be more confusing than a Math 151 lecture.  The bottom line is that we are all ultimately responsible for paying for our own health care.  So do your research and read the fine print – the answer will be in there somewhere, even if it’s not the one you’re looking for.   

John Vaughn, MD