Massachusetts lawmakers have put pen to paper in recent years to make birth control more accessible, but what you can get still depends on your insurance, your provider and your pharmacist. This guide walks you through what to expect and prepare for those conversations.
Insurance should cover the full cost of at least one brand for many types of birth control: one of the pill, the ring, the implant and so on. (Jill Clark, who directs the state’s Division of Child and Adolescent Health and Reproductive Health, pointed to an online resource from the state’s public health department to help residents figure out what benefits their insurance offers.)
“Everybody’s goals for contraception are different,” explained Dr. Luu Ireland, an OB-GYN at UMass Memorial Health and the section chair for the Massachusetts American College of Obstetricians and Gynecologists. Those goals could include being able to stop and start as desired, using birth control options without hormones or being as discreet as possible.
And remember: In Massachusetts, decisions about birth control can be made independently at any age.
To choose a type of birth control, one resource created with state backing is the decision aid made by Partners in Contraceptive Choice and Knowledge, or PICCK. Experts who spoke with GBH News suggested talking to your doctor and pharmacist about finding an affordable option under your insurance.
Read up on the pill, IUDs and implants, sterilization procedures, emergency contraception, and, finally, condoms, rings and other things.
What you want: The pill
One in five people at risk of becoming pregnant in Massachusetts are on “the pill,” a broad name that covers the many types of daily oral contraceptives.
The short answer: You can talk to your provider about your medical history and insurance coverage to see which option works for you. You can probably get a three-month prescription without any copay.
Or you can get progestin-only pills on the shelf at your local pharmacy. You can pick up a month’s supply under the brand name Opill for about $20 a month, no insurance involved, or $50 for a three months’ supply.
The longer answer: If you hunt around, you may be able to get a 12-month supply all at once. Under Massachusetts’ ACCESS Law, you are able to get a year’s supply prescribed by talking to your doctor, after a three-month trial run on that same medication — if you’re “fully insured.”
But there have been hiccups.
“It hasn’t rolled out quite as smoothly as we might have hoped,” said Clark with the state’s health department.
Doctors say they’ve found some pharmacists don’t have 12 months’ worth of a prescription in stock, and that a few are unaware they’re allowed to dispense more than a three-months supply.
GBH News called several pharmacies across Massachusetts to check. Many said they stock large enough supplies of many oral contraceptives, though there are many different brands so immediate availability varies. Other pharmacies said they could get a 12-month supply the next day if requested. But many pharmacists also said insurers don’t always cover such a large supply all at once.
Clark pointed out not all insurance plans are subject to the law.
“MassHealth and the group insurance commission that covers many state and municipal employees like myself are covered by the law,” she said. But other plans are less straightforward. If you have a “fully insured” plan, it’s subject to state law, but a “self-funded” plan is not. Here’s the state’s guidance on how to figure out which you have.
Note that none of those spot-checked pharmacies are Walgreens or CVS. At each of the locations this GBH News reporter called, this reporter was either directed to the corporate communications line or did not receive a response. Spokespeople for both chains said they dispense up to 12 months.
What you want: An IUD or implant
Many people like the “set-it-and-forget-it” factor of long-acting reversible contraceptives, which can last several years.
One option is the copper IUD, a small, T-shaped device that is inserted into the uterus. There are also multiple hormonal options, including other IUDs and the implant (sometimes called “the bar”) that’s inserted into your arm by a medical professional.
“Any OB-GYN, most family medicine physicians and a handful of pediatricians should be comfortable placing IUDs and contraceptive implants,” Ireland said.
And, under state law, you shouldn’t need prior authorization from insurance, so a same-day insertion may be available if staff is available to perform it. There’s no minimum age requirements, and, depending on your insurance, at least one brand should be fully covered at no cost.
IUDs are, by far, the most common long-acting reversible contraceptive in Massachusetts. Many people are wary of the pain that can come with an IUD insertion or removal, and several providers in Massachusetts have responded by making moderate or deep sedation available for the procedure.
What you want: Sterilization procedures
Some people are seeking permanent birth control options, which would mean a sterilization procedure.
The short answer: Tubal sterilization — or female sterilization, often known as “getting your tubes tied” — should be fully covered. When a person in an opposite-sex relationship is seeking a permanent form of birth control, Cannon advises patients that vasectomies, male sterilization procedures, are much less invasive procedures with fewer side effects. Many insurers cover vasectomies but they do not need to under state law.
If you are under 21, ask your doctor and insurance about eligibility. Some have age limits for sterilization procedures.
The longer answer: For female sterilization, the fallopian tubes are clipped or removed completely. To achieve permanency, Dr. Rachel Cannon suggests complete removal for a more effective procedure that’s performed under general anesthesia.
Cannon, an OB-GYN who is the medical director of the GYN Procedure Unit at Boston Medical Center, counsels patients on their contraceptive options. She says there are more often barriers to getting this procedure, compared to other birth control methods.
“If a patient is understanding of what a procedure is, what the risks and benefits are, and the permanence of a procedure, anybody — regardless of their age — is really able to make the decision to undergo permanent sterilization,” she said. “That’s the one that comes under the most scrutiny, though, when we think about age. But for every other type of birth control, there’s really no age restrictions.”
Ireland says some patients — especially young, unmarried people without children — find they have to go to two or three different doctors before they find one willing to perform tubal sterilization. She’s frustrated by what she called “very archaic thinking” among some providers.
“In a perfect world, you should be able to walk into any gynecologist’s office and be able to request sterilization,” she said.
When it comes to vasectomies, some family medicine practitioners, but not all, will perform them. They’re more commonly done by urologists.
“There are people who do it, but it’s a little bit less [than IUDs and implants],” Ireland said. “There’s a few more barriers to getting access.”
What you want: Emergency contraception
Emergency contraception, the morning-after pill and the brand name Plan B all refer to the same idea: taking pills orally within a few days of unprotected sex to prevent a pregnancy.
Plan B, or the generic version, is typically available on a pharmacy’s shelf, and each pharmacist reached by GBH News said it was stocked in their aisles.
Another form of emergency contraception is sold under the brand name ella and requires a prescription. Ella is more effective and is especially advised for anyone who’s over 165 pounds.
Pharmacists are also allowed, under law, to dispense emergency contraception themselves — ella or Plan B — as a prescription under a statewide “standing order” issued in 2022. That would eliminate any cost associated with the pills.
“Pharmacists may prescribe emergency contraception to individuals without a prescription. But they don’t have to,” explained Clark with the state’s public health department.
Among pharmacists contacted by GBH News, all stocked Plan B and most stocked ella. Some said they had prescribed emergency contraception under the state’s standing order, while others hadn’t or weren’t sure.
At CVS pharmacies in particular, a spokesperson says anyone looking to get Plan B or ella at no cost would need to obtain a prescription from an outside provider.
“[Over-the-counter] emergency contraception is available at all CVS Pharmacy locations — including those in Massachusetts — for purchase but we can’t currently bill the cost to insurance at the pharmacy without a provider’s prescription,” CVS spokesperson Amy Thibault told GBH News in an email.
Some colleges, including Boston University and Northeastern, have installed vending machines that sell emergency contraception on campus at a low cost. Plan B can cost $40 to $50 at a pharmacy.
What you want: Condoms, rings and other things
Condoms are widely available on pharmacy shelves and through online retailers. Ireland says some insurance plans do cover condoms and that she’s prescribed condoms before. If your health insurance plan includes a health savings account or flexible spending account, you may be able to pay for condoms out of that account.
Fully insured plans, under state law, have to cover a 12-month supply of several birth control options in addition to the pill. Those options include the ring, a small, hormonal ring made of flexible plastic that you put in your vagina for most of the month; the patch, a hormonal patch you put on your skin for one week at a time; and the shot, a hormonal injection once every three months.
