Why Do Birth Control Costs Vary Everywhere? We Investigate

When the Affordable Care Act (ACA) was passed in 2009, I remember thinking how great it would be to not have to pay for birth control once I was in college. Then, I went on my first birth control pill my freshman year and was hit with a $50 co-pay. Being 26 now and having had multiple health insurances from the various jobs I've held, that co-pay fluctuated between $25 and $50, but it was never completely covered. What gives?

For those who don't know, the ACA mandated insurances to provide coverage for women's birth control. The price disparity, it turns out, is all dependent on whether you are taking a generic pill or a brand-name one.

"Brand and generic birth control pills have to be chemically similar," says Sherry Ross, MD, women's health expert and author of She-ology. The Definitive Guide to Women's Intimate Health. Period. "The FDA requires that generic drugs have similar properties of the active ingredient that brand-name drugs use. But there are subtle differences."

She explains that the ACA completely covers generic birth control pills and that brand-name ones depend on your health insurance. To understand the difference between the two, think of a designer bag versus a bag you find at a chain retail store. The purpose of the bag stays the same, but you end up paying more for the details. 

Ross explains there are different ingredients that companies may add into generic brands to make it less expensive. She says they may differ in shape, color, and name, which all contribute to how something is priced. 

I take Lo Loestrin Fe, which gynecologists over the years have told me contains the lowest amount of estrogen. When I ask Ross about how a generic version of it would work for me, she says it has to contain the same amount of estrogen, but it could be a completely different type of estrogen. 

As for side effects (e.g. irregular period cycles or weight gain), you aren't necessarily paying more money to experience fewer side effects. She explains to me that any side effects women face are individualized; it depends on the person taking the pill. 

"If you take a generic, cheaper pill and have no severe side effects, that's the one to be on," she says. "I always ask patients if they notice anything different when they first get on the pill. Those little tweaks can cause changes you might not be comfortable with, and from there we change to another generic or brand name." 

But it is important to note that regardless of price and type of ingredients used, both a brand- and generic-name birth control pill have the same efficacy when protecting against pregnancy. 

"From a chemical standpoint, they both work the same way," she says. "The cause and effect and chemical component is the same." 

You find the difference in prices more so with pills than other forms of birth control, such as an IUD, because there are so many different types of pills. "There isn't a generic IUD," she says.

She also says to pay attention to what your insurance actually covers, because it can vary from state to state. "Different companies are more represented in certain states than in others," she says. "I have Blue Shield/Blue Cross, but my son can't have the same insurance where he lives. There are different guidelines, rules, and details of insurance plans state by state. It's important to note." 

So if your current birth control pill is taking too much out of your wallet, talk to your doctor about switching to a generic option or looking into other forms of birth control that might be more cost-effective. Planned Parenthood is also a great source to find affordable options.