When Malia Mason went into her university health center last December to refill her birth control prescription, she got some shocking news: She'd soon be shelling out $42 for each four-week pill pack of Ortho Tri-Cyclen Lo, she was told, instead of her usual $14. The 19-year-old sophomore at the University of Pittsburgh filled the rest of her yearly prescription at the old price, but she finally ran out this month and will have to come up with an additional $360 a year. "That's the cost of my yearly electric bill or half my books for a semester," she says. "I haven't yet figured out what I'm going to do."
University pharmacies nationwide have recently doubled or tripled the prices they charge for prescription contraceptives. A quirk in a new federal law, designed to save taxpayers money on Medicaid reimbursements for drugs, has effectively persuaded pharmaceutical companies to stop selling their products to these pharmacies at deeply discounted rates. (If companies continue to offer such discounts, the law stipulates, they will also receive lower payments from Medicaid.) As a result, 3 million college women who use birth control pills are now paying $30 to $50 a month for their favorite brand, up from an average of $5 to $10, according to the American College Health Association. "Some campuses had the resources to stockpile before the legislation took effect, but most are running out or have already run out," says Mary Hoban, who directs the ACHA's national college health assessment program office.
Clinics have already seen a drop-off in students filling prescriptions. The number of pill packs being dispensed at the University of North Carolina-Wilmington's student health center, for example, has fallen by a third since September, says pharmacist manager Ann Roth. Some health centers, like the one at Bowdoin College in Brunswick, Maine, have stopped stocking oral contraceptives altogether because they can't afford to maintain the pricier inventory. And many more are struggling to provide a full range of services because they can no longer rely on profits made from marking up the discounted products. The UNC health center used to earn about $5 to $10 from every pill pack sold, which subsidized physical exams, HIV testing, and medication counseling, says Roth.
One consequence could be a rise in unintended pregnancies, a major cause of college dropouts. What's more, without the incentive to get their yearly prescription renewed, fewer women are coming to health centers for gynecological exams, says Hoban. This means they also aren't getting screened for sexually transmitted diseases or being offered the new HPV vaccine, which can prevent cervical cancer. "We really have to get this issue fixed," says Cecile Richards, president of Planned Parenthood.
In the meantime, students can look for cheaper alternatives. Most university pharmacies now dispense generic oral contraceptives for $20 to $25 per pack. But about half a dozen brands of pills—as well as the vaginal insert NuvaRing and the patch—still have no generic equivalent, and some women may need to stay on a particular brand to avoid side effects like nausea, headaches, or frequent spotting, says Steven Sondheimer, a professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine. Students covered by their parents' health insurance might get a price break, but they'll probably have to go off campus since most university clinics don't accept insurance. Planned Parenthood clinics are another option; the vast majority still offer reduced rates for brand-name contraceptives. Women can log on to plannedparenthood.org to find the nearest clinic, though they should call ahead, says Richards, to make sure it has the discount.
Student organizations are also trying to find ways to ease the financial burden. At the University of New Mexico, a group called Spiritual Youth for Reproductive Justice has been helping to subsidize the cost of contraception. So far, it has given eight students an average of $103 each. "But this shouldn't be the end solution," says Ambrosia Ortiz, 22, who served as vice president of the group before she graduated last year. Students at New Mexico and other schools nationwide are organizing call-in campaigns directed at legislators, in an effort to get the discounts reinstated. Mason hopes that change will come soon. "I've had friends go off their birth control because they can't afford it," she says. "It's just completely ridiculous. If the government wants to promote safe sex on campus and no unintended pregnancy, they're really not sending a good message."