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FRIDAY, June 18 (HealthDayNews) -- Insurance plans fail to cover many newer reproductive health options such as contraceptive patches and rings, a new survey finds.

"Even when you include all methods of contraception available in this country, we still don't have enough," said Dr. Pablo Rodriguez, associate chief of obstetrics and gynecology at Women & Infants Hospital in Providence, R.I., and a board member of the Association of Reproductive Health Professionals.

"We still don't have enough safe and effective methods for all women to have adequate contraception, and that's one of the reasons we have such a high rate of unintended pregnancy," he added.

The new survey follows a recent study from the Alan Guttmacher Institute that showed a need for greater access to contraceptives for women, even though insurance coverage has increased over the past decade.

The survey, sponsored by the Association of Reproductive Health Professionals, the Black Women's Health Imperative, and Planned Parenthood Federation of America, canvassed 250 benefits managers at mid- to large-sized companies in the United States.

Almost 80 percent of these managers said their companies' insurance coverage of reproductive health was "excellent or good."

At the same time, only 40 percent to 50 percent of the companies covered newer contraceptive options such as injections, a vaginal ring, or a birth-control patch. Emergency contraception (the so-called "morning-after" pill) was covered the least often.

When it came to reversible birth-control techniques, the highest level of coverage was for oral contraceptives -- about 80 percent. Both the newer and older forms have been approved by the U.S. Food and Drug Administration.

For permanent birth-control options, the newer hysteroscopic sterilization -- when "plugs" are placed in the fallopian tubes -- was covered less frequently than older options such as tubal ligation and vasectomies. According to the survey sponsors, hysteroscopic sterilization is less invasive and less expensive.

Decisions about what options to cover tended to be made by the insurer and not the companies or the employees, the survey found.

Some experts believe the tendency to fund older contraceptive options over newer ones isn't limited to women's reproductive care.

"Insurers in general would like to keep costs down and are uninclined to approve multiple methodologies to accomplish the same thing. It doesn't come down to holding back on reproductive choice for women," said Dr. Steven Goldstein, professor of obstetrics and gynecology at New York University School of Medicine.

"These are instances where what they offer is a more convenient option rather than necessarily a medical advance. It's harder to make a case medically that this is some new breakthrough," Goldstein said.

If there are 15 statins -- cholesterol-lowering drugs -- on the market, Goldstein added, almost no managed care plan is going to cover all of them.

Rodriguez, however, thinks the problem is specific to women's health. "When Viagra and Cialis and all the erectile dysfunction medications came to the market, the insurance companies seemed to stumble all over themselves to cover it," he said.

Susan Pisano, a spokeswoman for American's Health Insurance Plans, an industry group, was unable to confirm whether erectile dysfunction drugs were generally covered. She did say, however, that "it is becoming difficult for employers to add benefits because of the cost and because there are cumulative effects of mandates to cover other things." Those mandates are from various states requiring that certain health-care options be covered.

According to Rodriguez, however, those mandates may improve coverage.

"The Alan Guttmacher survey showed that the states that have mandates for coverage of approved methods of contraception have excellent coverage," he said. "The problem is that half of the women in this country live in the 30 states where mandates do not exist. So one of the things that advocacy groups, medical groups and consumer groups need to do is to push for those states which don't have mandates to push for them in order to give insurance companies the extra push necessary."

Rodriguez told of one patient who requested a hysteroscopic sterilization. He performed the procedure, only to be informed by one of the country's largest insurers that it would not cover the cost.

"This patient had pulmonary hypertension and could not go under anesthesia," he said. "This procedure was much safer for her. The worst part about it is that the method is less expensive overall than the regular one. It is so, so shortsighted, and women are getting shortchanged by the system."

More information

See the complete survey at the Association of Reproductive Health Professionals.

(SOURCES: Steven R. Goldstein, M.D., professor of obstetrics and gynecology, New York University School of Medicine, New York City; Pablo Rodriguez, M.D., associate chief of obstetrics and gynecology, Women & Infants Hospital, Providence, R.I., and board member, Association of Reproductive Health Professionals; Susan Pisano, spokeswoman, America's Health Insurance Plans, Washington, D.C.; June 15, 2004, survey, Association of Reproductive Health Professionals )

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