College students face rising birth control prices

College students returning to campus in a few weeks will be greeted by steep increases in one of the few items they have been able to buy cheap: birth control.

For years, drug companies sold birth-control pills and other contraceptives to university health services at a big discount. This has served as an entree to young consumers for the drug companies, and a profit center for the schools, which sell them to students at a moderate mark-up. Students pay perhaps $15 a month for contraceptives that otherwise can retail for $50 or more.

But colleges and universities say the drug companies have stopped offering the discounts, and are now charging the schools much more. The change has an unlikely origin: the Deficit Reduction Act signed by President Bush last year.

The legislation aimed to pare $39 billion in spending on federal programs from subsidized student loans to Medicaid. Among the changes was one that, through an arcane set of circumstances, created a disincentive for drug makers to offer school discounts.

Colleges and universities say the change is having a significant impact on their health centers and the students they serve. Prices have begun skyrocketing for many popular brands of birth control. Health centers are having to reconfigure their offerings and write new prescriptions. And college students are making some tough choices, such as switching to cheaper generic brands or forgoing their privacy in order to claim their pills on their parents' insurance.

The changes actually took effect earlier this year, but when it became clear to college health providers that the economics were going to change, many of them stocked up on several months' worth of supply. Only lately has that cheaper supply begun petering out. Some students started seeing the steeper prices last spring and some are dealing with it now during summer sessions, while others won't see it until they return for the fall semester.

In recent months, at Michigan State University in East Lansing, the price of Ortho Evra, a birth-control skin patch by Johnson & Johnson, more than doubled to $50 for a month's prescription from $20 last year. At the University of Iowa in Iowa City, Ortho Tri-Cyclen Lo, a low-estrogen pill also by J&J, rose to $52 recently -- from $16 last year. The University of Texas at Austin now charges more than $50 for Organon Inc.'s popular NuvaRing, a monthly vaginal device, from $12.

To save money, at the University of Iowa, about three-fourths of students on Ortho Tri-Cyclen Lo -- a pill that has no generic form -- have switched to a less-expensive option.

Such changes concern health professionals, who fear that switching is going to lead to unintended pregnancies by women who are less likely to consistently take a daily pill.

"One of the seminal concepts in contraceptive medicine is when a woman is using a method correctly and successfully, the last thing you want to do is change her from that," says Lee Shulman, board chairman of the Association of Reproductive Health Professionals. "You don't want to change her unless there is an absolute medical necessity to do so."

He says even switching from one type of daily pill to another can pose new risks for side effects and discomfort, potentially leading women to stop taking it.

At drug maker Organon, Nick Hart, executive director for contraception, says, "On the one hand, it's a tremendous disservice to our customers, our young women." He adds that providing low-cost access to young consumers has to be balanced with "our fiduciary responsibility. It puts us in an untenable position."

A Johnson & Johnson spokeswoman said because of the new legislation, only institutions that qualify as "safety net" providers under the law will get the company's discounted prices. Safety-net providers include certain facilities that serve low-income families.

Health professionals say it's particularly critical for college women to have access to cheap contraception. Two-thirds of college students reported having at least one sexual partner in the prior 12 months, according to a fall 2006 survey of more than 23,000 students by the American College Health Association. Condoms have been available free on many campuses, and are considered the best form of contraception for preventing sexually transmitted infections.

"Maybe, if more people switch from hormonal methods to condoms, we may see a positive outcome of fewer STI's," says Mary Hoban, a project director for the American College Health Association. "From a contraceptive standpoint, we may see more unintended pregnancy. It's a double-edged sword."