Sexual health clinics grapple with hike in birth control prices

Sexual health clinics in southwestern Ontario that offer low-cost birth control say they've had to increase the price of a number of their products—sometimes by nearly threefold—due to an increase in manufacturer costs.

The clinics at the Middlesex-London Health Unit (MLHU) and the Huron County Health Unit are aimed at patients who have barriers that restrict their access to birth control, such as those who don't have family doctors or who aren't eligible for a drug benefit plan.

"When these costs go up, absolutely we start to wonder whether people will be able to access these medications in the same way," said MLHU associate medical officer of health Dr. Alex Summers.

At the Middlesex-London Health Unit (MLHU), the products affected are:

• Birth control pills Alesse and Minovral which have increased from $7 to $15 a month.

• Birth control pills Demulen and Synphasic, which have increased from $7 to $20 a month.

• Depo, a contraceptive injection, which has increased from $25 to $35 a month.

At the Huron County Health Unit, public health nurse Kate Underwood said the products affected are:

• Alesse, which has increased from $7 to $17 a month.

• Demulen and Minovral, have increased from $7 to $20 a month.

At the Huron County Health Unit, the new prices came into effect January 2, 2019.

At the MLHU, the new prices will be effective as of March 30, 2019.

Pfizer Canada, which manufactures the products affected, told CBC News in an e-mail statement that the company has had contractual agreements with Canadian women's health clinics for more than 10 years, but said those agreements are changing.

"Due to changes in the reimbursement landscape and the availability of many contraceptive options, including a wide range of patented and generic options, Pfizer Canada is announcing this week that it will no longer offer the previously contracted pricing," said Heather Bisset, senior manager of corporate affairs, in an email statement February 12.

Pfizer Canada said it continues to make their products available to clinics at the list price, and supports clinics through patient education.

Why low-cost birth control is important

As a business, Pfizer Canada has a responsibility to its shareholders to maximize profits—but that doesn't mean its decisions don't have an impact on the wider community, said Lauren Cipriano, an assistant professor at the Ivey Business School who studies health policy.

Cipriano pointed out that although the "reimbursement landscape" in Ontario has changed in recent years to offer drug coverage to those under 25, young people aren't the only ones who need low-cost birth control.

"I think the women who are going to be affected here are working low-wage jobs without benefits, contract workers and the self-employed," said Cipriano, who pointed to hairdressers, child and eldercare providers and home cleaners as examples.

"This is a large group of women who fall between the provincial drug plans and coverage through work-provided plans, generally associated with higher income and secure employment."

What's more, Cipriano said the same women who may not have work-provided coverage for birth control are also less likely to have access to maternity leave if they do have an unplanned pregnancy.

"And so this would be a significant additional hardship I would imagine for those families," she said.

Barriers to birth control take on an added level of complication for those living in rural areas, said Underwood. The community where she works doesn't have a transit system, which means patients at the birth control clinic need to access a vehicle potentially take time off work in order to get there, Underwood said.

"All of that comes with a cost," said Underwood. "It kind of creates a domino effect."

What comes next

The MLHU and the Huron County Health Unit have plans to respond to the cost increases.

Dr. Summers and Underwood say they're working to connect patients with benefit plans they may not realize they're eligible for, and to offer them alternative forms of birth control if they're a good fit.

For instance, Underwood said her clinic has brought in a cheaper, generic version of Alesse, which is a popular birth control choice for many patients.

Still, Underwood said she wants patients to be able to take the contraceptives that work best for them—not strictly the ones that are cheapest.

"As much as the brand name and the generic are fairly similar in their production, there can be some differences, and everyone's body is a little bit different," said Underwood.

"They would rather have a product that works for them, versus having to choose something that's cheaper and they're not getting that cycle control and they could have an increased risk of pregnancy."

For Cipriano, the situation speaks to a broader need for universal pharmacare in Canada. Cipriano said unplanned pregnancies are costly to women and to society, and that investing in low-cost birth control would be a good value proposition for Canada as a whole.

"National pharmacare isn't just a conversation about high-cost, rare drugs needed in more extreme health conditions in our lives, but also part of our everyday preventive health," she said.