On Wednesday, the U.S. Supreme Court ruled in a 7-2 decision that businesses and universities with religious or moral objections to providing employees with insurance coverage for contraception can deny that coverage.

In their dissent, Justices Sonia Sotomayor and Ruth Bader Ginsburg wrote that the judgment means between 70,500 and 126,400 women will lose access to no-cost birth control.

Providers who prescribe birth control through apps and online pharmacies say the ruling is unlikely to significantly affect their practices. But they stress the importance of patients being able to make their own reproductive decisions – and fear that the judgment will make it harder for patients, especially those who rely on insurance, to get birth control. 

"We’re deeply disappointed by the court’s ruling on the ACA contraceptive mandate. Cost is one of the biggest barriers when it comes to birth control," said Dr. Amy Roskin, head of clinical operations and medical director at the birth control prescription and delivery service Pill Club.

Patients who can currently get birth control at no extra cost may, depending on their employer, find themselves expected to pay out of pocket. Roskin pointed to a study that found an estimated $1.4 billion in co-payment savings during the first year the ACA was in effect.

Roskin noted that because Pill Club prescribes and delivers medication for people with and without insurance, "Our ability to provide these services won’t change with the court’s ruling."

Still, Roskin said, "reversing this mandate is harmful to women, especially people from marginalized communities who already experience far more barriers to reproductive health care." 

At Alpha Medical, which provides birth control and other medication online, Chief Medical Director Dr. Mary Jacobson says about half of customers already pay with cash, meaning the Supreme Court ruling on contraceptive coverage won't affect those patients' existing habits. 

Although its customer base won't necessarily change after the ruling, she said, "what they choose is going to differ." Because birth control pills tend to be less expensive than options such as once-monthly vaginal rings or birth control patches, Jacobson said, "I think the number of women opting for the pill would shift."

"What I'm concerned about is the long term," said Jacobson, who questioned what will happen if major employers decide that covering birth control is morally objectionable. She noted that long-acting reversible contraceptives, which tend to have higher efficacy and lower user error rates than many other forms of birth control, are less affordable. 

"Down the line, as an OB-GYN, as a women's health advocate, I find it very concerning," she said.

Dr. Julie Graves, associate director of clinical services for the Nurx birth control app, agreed that a lack of insurance could push longer-acting methods such as "the shot" out of reach.  

"A lot of birth control is used to treat underlying reproductive organ health conditions," such as polycystic ovary syndrome, she said. "I think we're all very afraid that this kind of care will get caught in these prohibitions."

Dr. Davis Liu, chief clinical officer of Lemonaid Health, predicted that the company may actually see an uptick in patients given the potential low-cost option of paying in cash rather through insurance. Even patients who do have insurance, he said, may prefer the cash option because it lacks the constraints – such as only being able to get a month's supply at a time – that insurance companies may impose.  

"The potential ruling is not going to impact us negatively," he said. Though the majority of current patients do have health insurance covering birth control, he continued, "patients who lose coverage will seek us as well."

"How the government rules, how coverage changes, that's between the government, insurers, and companies," he said. "But patients' needs don't change. They still need care. We're more than ready to handle any sort of uptick."

At Pandia Health, CEO Dr. Sophia Yen predicted that more people will turn to cash options in lieu of relying on insurance. But those who encounter barriers to doing so, she warned, "may choose to forgo the medication."

This goes beyond contraception. She noted that people using birth control for other medical reasons could "risk losing their ovary or suffering pain" if they can't access it. 

Like Jacobson, she's also seen cost drive patients from more effective methods to less effective ones.

"It's fiscally stupid and morally wrong to not cover birth control," she said.

"My message to employers and insurers is: Just because you can avoid [covering birth control] doesn't mean you should," said Graves. "Think about what is best for your business."

"We're facing a serious economic crisis during the COVID pandemic," she continued. "We should as a nation be making it easier and more affordable for people to access care."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.