Massachusetts residents are still being denied easy access to long-term birth control prescriptions they were guaranteed under a bill Governor Charlie Baker signed into law nearly four years ago.
The emergency measure was rushed into law in the early Trump era when the president tried to gut the Affordable Care Act’s guarantee of free birth control. The law ensured contraception would remain free in Massachusetts, and required insurers to cover a year’s supply of birth control pill packs, rather than meting them out monthly or quarterly.
But women continue to report that they’ve been denied such long-term prescriptions by doctors, pharmacists, and insurers who insist they’re not entitled to what the law promised.
“Honestly, everyone at every turn was like, ‘I don’t know what you’re talking about,’” said Shannon Alessandroni, a 24-year-old state legislative aide whose 12-month prescription sent her on a contraceptive odyssey in May.
The inaction has frustrated advocates and sponsors of the ACCESS law — “An Act Relative to Advancing Contraceptive Coverage and Economic Security in our State” — one of whom accused Baker of being “indifferent” toward its implementation.
“It’s the administration’s job to implement a law,” said that sponsor, Senator Harriette L. Chandler, a Worcester Democrat. “It was their job to ensure that pharmacies and health plans knew of the new benefits that they were mandated to provide. It seems that the administration’s responsibility fell through the cracks.”
Chandler was among the female leaders who stood behind Baker when he publicly signed the bill into law in November 2017. At the time, Baker called it “a great day in the Commonwealth of Mass.”
But the administration still has not finalized regulations dictating how pharmacies should dispense contraception under the state’s Medicaid program, MassHealth, whose existing regulations limit contraceptive prescriptions to three months. The new regulations were proposed in 2019 but never finalized. The Division of Insurance sent a bulletin alerting private carriers to the changes in August 2020 — nearly three years after Baker signed the bill. The law also called for the state insurance commissioner to ensure compliance, but advocates say they have seen no evidence of enforcement.
A spokeswoman for the Executive Office of Health and Human Services, Kayla Rosario-Muñoz, did not directly answer a question about the delays.
Instead, she said in a statement: “MassHealth is committed to implementing the ACCESS Law and has continued to communicate with its members, health care providers, pharmacies and other stakeholders about the law’s requirements.”
Baker, who made his name in health care management as a state health secretary and chief executive of Harvard Pilgrim Health Care, is a Republican governor who supports abortion rights. However, late last year, he angered activists by vetoing a bill that protects and expands abortion rights under Massachusetts law. (The Legislature overrode his veto.)
Birth control pills — approved by the FDA more than 60 years ago — have traditionally been refilled by prescription every month or three months. Some in the medical community initially worried about expanding that to 12 months, noting that patients often switch the pill they’re taking, based on particular health effects, noted Lora M. Pellegrini, president and CEO of the Massachusetts Association of Health Plans. What would they do with the extra packets in their medicine cabinet? Would they be tempted to share with a friend who also wants a change?
But some people remain on the same pill for years, and research shows they are less likely to have a lapse — and an unintended pregnancy — if they have a 12-month supply on hand.
The ACCESS law does not apply to those who are self-insured — including employees of many large companies that handle their own plans. But its language explicitly applies to members of the state Group Insurance Commission, which covers state employees like Alessandroni.
And it should cover MassHealth members like Alessandroni’s sister, who she said was denied a long-term prescription in July — even though MassHealth had sent a bulletin to pharmacies saying it was permitted during the pandemic and that the change should become permanent.
Alessandroni said she helped her sister navigate the health care bureaucracy after fighting her own battle. When she first sought her own prescription, Alessandroni said, her doctor wasn’t aware of the law, then her pharmacist would not honor the 12-month prescription, even after she showed him the Massachusetts General Law citation.
“The pharmacist is like, ‘I don’t know what this law is and your insurer did not preapprove this, so you can’t have it,’” Alessandroni said.
After getting the runaround from her health care provider, she reached out to a reproductive rights advocate, who contacted the Division of Insurance and the Massachusetts Association of Health Plans.
The answer seemed bafflingly simple.
“It was just that the pharmacist didn’t know how to input the code correctly,” Alessandroni said.
Another woman, 34, who formerly worked in health care policy, and who did not want to be identified because of her proximity to politics, said two CVS pharmacies refused to fill her 12-month prescription. One did not have enough medication on hand; the second was only willing to dispense three packs, and she gave up protesting in a long pharmacy line amid the pandemic. Then, when that prescription was about to run out, she was unable to refill the remaining nine months’ worth; it had been voided in the pharmacy’s computer system after she accepted the limited order.
That led to a series of panicked calls to her doctor’s office, where a nurse told her the doctor was tiring of rewriting prescriptions for patients in the exact same predicament.
“There’s a lot of people who might just give up on it and say, ‘I can’t get my birth control prescription so I’m going to just stop taking it,’” she said.
Pellegrini, who represents 16 health plans, did not fault the Baker administration, saying her plans and providers were made aware of the changes from the start.
“We have done more to educate on this particular mandate than any other mandate in my recent history,” she said.
But state lawmakers frustrated by the lack of attention from the state, are mounting a new effort to publicize the ACCESS Law, recently budgeting $500,000 for a public awareness campaign by the Department of Public Health.
“I think it’s fair to say that we are feeling incredibly frustrated by the leadership failings of the Baker-Polito administration at this point,” said Rebecca Hart Holder, executive director of NARAL Pro-Choice Massachusetts, which championed the law.
While it’s unclear how many patients are requesting the medication and being denied, it’s clear few are getting it. Only 32 of the 25,000 Harvard Pilgrim Health Care members who had prescriptions for oral contraception last year got 12-month supplies, according to spokesman Philip Tracey. This year, only 45 have filled them. Harvard Pilgrim has since combined with Tufts Health Plan to form Point32Health, and has been reminding providers, pharmacies, and members of the availability. Likewise, the Massachusetts Association of Health Plans launched a public awareness campaign for consumers in March, after Commonwealth magazine first reported on the limited use of the law.
State Senator Cindy Friedman, an Arlington Democrat, said she was led to believe regulations were imminent six months ago, when she addressed the issue with officials at MassHealth.
“I can’t imagine what the problem is,” said Friedman.
“What are you to think? That women don’t matter?” she asked. “No one’s ever explained to me why this is difficult to do.”