Make birth control accessible, affordable

North Carolina isn't exactly considered a champion of reproductive rights.

So it may come as a surprise that North Carolinians can now get hormonal birth control without a doctor's prescription, thanks to a law initially passed last year by the state's Republican-controlled legislature and signed by Democratic Gov. Roy Cooper.

The law, which went into effect Tuesday, allows pharmacists to dispense birth control pills and patches without the signature of a patient's physician, removing a significant, unnecessary barrier that prevents many people from obtaining hormonal contraception.

It almost sounds too good to be true — and it very well may be. The law is clear that people will now be able to obtain birth control without a prescription, but it's less clear whether their insurance will still have to pay for it.

Under the Affordable Care Act, most insurance plans are required to cover FDA-approved contraceptives with no out-of-pocket costs when prescribed by a health care provider. That provision significantly reduced the cost of birth control for many, but faced strong objections from conservatives. The Trump administration later undermined that mandate by allowing for broad religious and moral exemptions, which the U.S. Supreme Court eventually upheld in a 2020 ruling.

But the requirement doesn't seem to apply to contraceptives dispensed without a prescription — meaning that those who would benefit from getting birth control without the added trouble of a doctor's visit might still be shackled with the burden of paying for it. Without insurance, the birth control pill can cost as much as $600 a year, an expense that is unmanageable for many people.

Since the law only went into effect this week, the state health director hasn't yet provided specific guidance — otherwise known as "standing orders" — that instructs pharmacists how to carry it out. That guidance should come quickly in order to clarify whether or not birth control dispensed without a prescription will result in co-pays or other out-of-pocket costs.

In other states where birth control is available without a prescription, such as California, the law was written to specifically mandate coverage for both prescribed and non-prescribed contraceptives. But North Carolina's law doesn't include such a provision.

It's not for lack of trying. Rep. Julie von Haefen, a Wake County Democrat, introduced a bill that would have specifically addressed the affordability aspect. In addition to empowering pharmacists to dispense birth control without a prescription, House Bill 817 would have required insurers to cover both prescription and nonprescription contraceptives. Unfortunately, the bill did not gain any traction in the Republican-controlled legislature.

But Jillian Riley, the North Carolina director of public affairs for Planned Parenthood South Atlantic, said that birth control dispensed by a pharmacist could still be covered by insurance due to a different state statute that requires reimbursement when services normally covered by a person's insurance policy are performed by a different licensed health care provider.

Surprisingly enough, making hormonal birth control more accessible is something that has enjoyed a fair amount of Republican support over the years, particularly at the national level. It was a big talking point for U.S. Sen. Thom Tillis when he first ran for office in 2014, as well as for a handful of other Republicans running in battleground states.

It's even an issue that U.S. Rep. Alexandria Ocasio-Cortez and U.S. Sen. Ted Cruz famously —and strangely — agreed on back in 2019. What Democrats and Republicans don't agree upon, however, is who should pay for it. While the GOP appears to support measures that make birth control more available, the party has been less enthusiastic about making sure everyone can afford it.