Will insurers cover abortion pills?

Many pharmacy benefit managers and insurers say that they will cover the RU-486 abortion pill (Mifeprex). However, they are leaving it up to employers to decide whether to extend the benefit to their employees.

In September 28, 2000, this pill was approved by the United States Food and Drug Administration. According to the companies’ spokespersons, the abortion pill is covered as a standard medical benefit by Aetna U.S. Healthcare, CIGNA, and the United HealthCare. 

Because the pill is not a contraceptive, it was placed   in its own therapeutic class by AdvancePCS, a pharmacy benefit management and health improvement company that proves 450 million pharmacy claims per year.

AdvancePCS will not process claims for the drug unless an employer informs AdvancePCS that the drug is covered under the employer’s plan, according to consultant relations analyst Sharon Dawson.

The pill known as Mifepristone (trade name Mifeprex, also known as RU 486) is used for termination of early pregnancy usually defined as 7 weeks (49 days) or less, counting from the beginning of the last menstrual cycle. Progesterone, a hormone that is needed for pregnancy to continue, is what is stopped by Mifepristone.

The cost of the medical abortion procedure should include three doctor’s visits, counseling, and the price of the drug. The cost is actually comparable to surgical abortion which will end up ranging anywhere from $700 to $1,200.

Will employers shoulder the big decision? They might. Even though insurers generally agreed to cover Mifeprex, that doesn’t mean that your employer might have the tendency to agree doing so. They can always disagree to offer this sort of benefit for their employees because they end up paying a portion of your premium, and it is up to them to decide what coverage you should have on your policy.

Because many employers don’t want to subject themselves to pickets from anti-abortion protesters, says David Albertson, editor of Employee Benefit News, a publication for benefit managers. You see, there are much more reasons why employers wouldn’t offer this type of coverage for their employees.

“Coverage will remain a matter of corporate culture and corporate conscience” says Albertson. He later points out that even though some employees are afraid of being pickets to anti-abortion protesters, that doesn’t necessarily mean that it is a social or moral dilemma. He claims, “We went through it before with surgical abortions and the domestic partner issue. Just a few years ago, only a handful of major employers offered benefits to domestic partners, now it’s almost routine.”