Health Benefits, Savings Seen in New Free Contraception Plan

British Columbia will be the first province or territory to make prescription contraception free starting April 1, a move one expert, Dr. Ruth Habte, said offers “a beacon of hope” for the rest of the country.

This week’s provincial budget allotted $119 million over the next three years to eliminate out-of-pocket costs for prescription contraceptives including oral hormonal pills, contraceptive injections, sub-dermal implants, copper and hormonal IUDs and Plan B, the morning-after pill.

Finance Minister Katrine Conroy said removing the cost barriers will help prevent unwanted pregnancies and give more people fuller control over their reproductive health.

"All too often, these fundamental rights are under attack," she said as she tabled the budget in the legislature Tuesday. "Not here in B.C."

The province estimates this measure could save someone paying $25 per month for hormonal birth control pills up to $10,000 over their lifetime. IUDs, which last between three and 10 years, can cost around $500 each without private insurance coverage.

And it could save B.C. up to $95 million in health care and social costs each year, according to a 2010 study from Options for Sexual Health. About one in five women in Canada will have an unwanted pregnancy, according to a 2016 study published in the Canadian Medical Association Journal.

Public health experts and advocates say the measure will give people more choice in their reproductive health and should set an example for the rest of Canada.

“This policy is really timely, I’m excited how the government has done this in such a broad way,” said Dr. Habte, an obstetrics and gynecology resident physician at the University of British Columbia and organizer with non-profit AccessBC, which has advocated for free prescription contraception since 2017.

Starting April 1, people seeking contraception will need to present a prescription from a doctor and their MSP card to a pharmacist to have the cost waived. 

And in May pharmacists can begin to prescribe and dispense contraception directly to patients as the government expands their scope of practice to alleviate the burden on primary care physicians.

Prescription contraception is used to prevent unwanted pregnancies and can also be prescribed for serious health issues affecting people with uteruses, including endometriosis, painful periods, fibroids and polycystic ovary syndrome. It is different than the medical abortion prescription drug Mifegymiso, which has been available for free in B.C. since 2018.

Last year, B.C. announced prescription contraceptives would be covered by PharmaCare, the public drug plan for people with low incomes or who are on income or disability assistance.

Habte said expanding free prescription contraception to everyone will make it easier for all low- and moderate-income people and those in abusive relationships or controlling households to prevent unwanted pregnancies and care for their health.

“Many have zero control over the money in their household, so it’s incredibly impactful for them to access that contraceptive of their choice at no cost,” said Habte. An unwanted pregnancy significantly increases the risk of intimate partner violence and can further tie the pregnant partner to their abusive partner or situation, she noted.

But prescription contraception, like medical or surgical abortions, is still harder to access for people living in smaller communities and rural areas.

Family doctors or pharmacists may not want to prescribe contraception, and stigma could keep patients who know their health-care provider personally from asking for it. Visiting a pharmacy regularly to get their medications can be a challenge for people in remote areas.

And this measure won’t help people new to B.C., including temporary foreign workers and refugee claimants, until their three-month waiting period for MSP is over.

Habte said limited access to contraception and abortion care results in more unwanted pregnancies and serious health issues that require costly hospital care.

“Patients who don’t have MSP and fall pregnant often are not able to pay for an abortion… so our health-care system is providing the emergency care needed to deliver a baby for someone who didn’t have health insurance and hadn’t been able to get an abortion or even contraception,” said Habte. 

“That person could have avoided such a stressful, life-altering experience if they had had access to contraception to begin with.”

Habte hopes the policy will soon include people who don’t have MSP coverage and lead the way for ongoing free contraception campaigns in Ontario and Manitoba.

“This should be as expansive a policy as possible,” she said. “I hope other provinces follow suit.”