The recent Supreme Court decision that enables closely held* companies to choose which contraceptives their insurance programs will cover could affect patients who seek to reduce their risk of certain types of cancer.
The contraceptives in question in this case—Burwell v. Hobby Lobby Stores, Inc.—are two forms of emergency contraceptives (eg, the so-called morning-after pill), and two forms of the intrauterine device (IUD), which are pregnancy prevention tools, but viewed as abortifacients by some outside the medical community.
Meanwhile, there are broader uses for these medications outside of pregnancy prevention, and access to those medications may be hampered and also priced out of reach for some once insurance coverage is dropped.
The ruling loosened the Affordable Care Act’s (ACA) mandate that employers provide all types of contraceptives to employees. Hobby Lobby, a chain of arts and craft stores that employs approximately 13,000 people, stated that this provision of ACA is in conflict with their religious beliefs, citing the Religious Freedom Restoration Act, enacted in 1993 to prohibit the government from burdening a person’s exercise of religion.2
“This decision puts women at risk by making oral contraceptives less accessible—based solely on an employer’s personal beliefs,” said Calaneet Balas, CEO, Ovarian Cancer National Alliance in a recent press release.3
In response to the Supreme Court ruling, the Alliance submitted a brief to the court explaining how a 5-year prescription of oral contraceptives can work to prevent ovarian cancer in women who are at high risk. With the new exemption to employers, risks are brought on to the employees.
“….a decision by this Court in Plaintiffs’ favor would allow employers to claim entitlement to exemption from the contraceptive-coverage provision as to all FDA-approved contraceptives, including oral contraceptives,” the brief stated.4
Employees in this specific scenario are still able to obtain most forms of contraceptives, including birth control pills, but will have to pay out of their own pocket for four specific drugs and devices. An IUD can cost as much as $1,000 without insurance. The question yet to be answered is whether this ruling will be interpreted more broadly in the future and if this decision will have overreaching implications for other companies and medicines going forward.
Cancer Risk Reduction Is Key
An important point in this hotly debated topic is that some of these medications have other uses. For example, ulipristal acetate, the generic term for the “morning-after pill” Ella® has been administered to patients being treated for uterine fibroids,5,6 a gynecologic condition that can lead to endometriosis and infertility. Endometriosis can also have problematic complications—endometrial cancer and ovarian cancer, according to the Mayo Clinic.7 The IUD can also prevent endometrial cancer.4
So that brings us back to the Supreme Court ruling, which may more broadly affect patients beyond those who seek emergency contraception.