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Wednesday, August 21, 2019

Anti-abortion rule prompts rejections of family-planning funds; CVS squeezes mail-order contraceptive sellers

Rural residents may soon find it more difficult to access some forms of reproductive health care.

Planned Parenthood and some other reproductive-health providers, including some governments, have announced they will stop taking about $60 million in annual federal funding for low-income women's reproductive health services because a new Trump administration rule bars grantees from making referrals for abortions. "That loss in federal funding could deliver a heavy blow to already cash-strapped, non-profit clinics that are often the only providers in their communities offering low cost services," particularly in rural areas, Jessie Hellman reports for The Hill. "Other organizations, including Maine Family Planning, have dropped out of the program because of the new rule. Governors in Hawaii, Illinois, New York, Oregon and Washington have all stated they will withdraw . . . and state legislatures in Maryland and Massachusetts have passed laws saying they would."

The family-planning program, Title X, has provided birth control and other reproductive care to young, poor women for almost 50 years. It serves about 4 million patients a year, most of them black or Hispanic, and sends $260 million a year to clinics. "The program has helped fill gaps in health care access including cancer screenings, STD testing and annual exams for women who are poor or don't have health insurance. It does not fund abortion care," Nicquel Ellis reports for USA Today. "Planned Parenthood has been the largest provider, serving 40 percent of all Title X patients."

Program participants had to submit statements to the government by Monday saying they would comply with the new rule, which will be enforced starting Sept. 18. "In addition to the ban on abortion referrals by clinics, the new Title X rules include financial separation from facilities that provide abortions, designating abortion counseling as optional instead of standard practice and limiting which staff members can discuss abortion with patients," Ellis reports. "Clinics would have until next March to separate their office space and examination rooms from the physical facilities of providers that offer abortions."

Planned Parenthood is the only Title X recipient in some areas—such as the entire state of Utah—and serves a disproportionate amount of the poor in other places, including many rural areas. Alexis McGill Johnson, the acting president and CEO of the Planned Parenthood Federation of America, said that if Planned Parenthood facilities are forced to scale back or close, it will be impossible for other health centers to fill the gap, Ellis reports.

"Planned Parenthood and a host of states are suing the administration, with an appeals court holding hearings next month," Hellman reports.

Meanwhile, in July CVS Caremark began reimbursing mail-order prescription delivery companies less, including birth-control service Pill Club. Pill Club protests that the rate change threatens its ability to keep operating, Garnet Henderson reports for Vice.

Mail-order services like Pill Club, Nurx, and Pandia Health allow patients to get a prescription via virtual consultation with a doctor, then deliver the meds by mail. It's popular in rural areas, especially for women who don't have insurance or have other difficulties finding reproductive care. "According to Pill Club, 70 percent of its users previously had difficulties obtaining birth control, and 55 percent said they would have to stop taking birth control without Pill Club," Henderson reports.

CVS Caremark is a pharmacy-benefits manager, a third-party company that manages prescription benefits on behalf of insurers and Medicaid programs. It's a subsidiary of CVS Health and sister to the ubiquitous CVS Pharmacy chain. A CVS Caremark spokesperson confirmed the rate change, but said Pill Club's accusations were "extremely misleading" and that the decision was not specifically aimed at, nor would have any impact on, access to contraceptives, Henderson reports.

Sophia Yen, CEO and co-founder of Pandia Health, said small pharmacies (which is essentially what such services are) are threatened because they can't get discounts by buying in huge volumes like the top three or four pharmacy benefit managers can. She also noted that CVS offers its own mail-order service, and suggested the move might be an attempt to undercut competition, Henderson reports.

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