My final word on Fluke and contraception

I think we can all agree that over the past week and a half, the issue of Sandra Fluke’s testimony and contraceptive coverage has been discussed pretty exhaustively hereabouts.  We’re dealing with a dead equine at this point, and I don’t want to belabor the conversation.

That said, I have one last thing on my mind, which still niggles a bit.  It has to do with whether or not prescription contraception is something that a woman can easily afford, and that she should be expected to pay for out of pocket.  The figure that has been bandied about is about 20 bucks per month, with the clear implication being that sexually active women can easily bear this cost and should do so rather than expect others to pick up the tab for their recreational coitus.  From this, some have criticized Ms. Fluke for inflating the costs of contraception when she stated that it could cost around $1000 per year.

I’ve already said that I think contraception should be covered by insurance, full stop, regardless of how much or little it costs.  But I want to pick apart that affordability argument a little bit.  Then I’ll be done, I promise.

As it happens, right now there is a recall on Lo/Ovral, a commonly prescribed hormonal contraceptive.  (The recall is related to an error with pill packaging.)  Our practice has a fair number of patients who were on Lo/Ovral, all of whom have to be switched to something different, and as the adolescent medicine specialist I’ve been fielding a lot of the questions from colleagues.  The trouble is that many of the generic formulations are also involved in the recall, so finding a good alternative has been tricky in a lot of cases.

I’m not going to bore you with a discussion of monophasic vs triphasic pills, or varying estrogen and progestin content from pill to pill.  My reason for bringing this up is that, as we switch patients to other OCPs, we’re getting a lot of calls back reporting that only the name brand is available in the substituted formulation and can we please try another, because otherwise the patient is going to have to pay $50 or more.

Hormonal contraceptive pills are complex medications.  Different formulations have different side effect profiles, and also different benefits if you’re using them for non-contraceptive benefits.  (Some patients use them for both!)  In many cases, a patient has to be on a certain pill because she can only tolerate a specific dose or type of hormone.  Sometimes that formulation is available as a generic, and sometimes it isn’t.

All of this is to say that yes, in fact sometimes women do have to pay hundreds of dollars per year for OCPs, and that Ms. Fluke’s figure isn’t a crazy distortion.  It may not be pertinent for all or even most women, but it actually may be accurate for some.  Given some of the commentary I’ve read about her testimony, I thought it was important to clarify that point.

Thank you.  I’m done now.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Thank you. This tallies well with what I saw elsewhere as I was trying to figure out the facts on this point. It does appear that Ms. Fluke gave a figure that was inaccurately high, but not by nearly as dramatic a margin as her critics claim.

    It’s unfortunate that we can’t clearly define the boundary between misestimating and lying–it might have saved us all some trouble.

    • I’ve gone by the assumption that her “estimate” included a couple doctor visits (to get and follow up on the prescription). Her estimate is “high-ish,” but credible, exactly what I’d expect and advocate to put forth.

  2. I sure am glad the Obama people are curbing wasteful spending on annual mammograms and expensive breast cancer drugs like Avastin so they can pay for birth control pills, or Ms. Fluke’s other proposal for insurance mandates, coverage for sex re-assignment surgery.

    • Hello, Never. Thanks for stopping by.

      Your comment brings to mind something that happens every so often when I’m talking to someone. I’ll open my mouth to say something, and then realize that there’s absolutely no point in doing so — there isn’t a blessed thing I’m going to say that will make a difference in what the other person thinks. I can dust off everything I ever learned in debate and forensics, I can wheedle and plead and hector, but the other person’s mind is an adamantine mass. And so I silently shut my mouth again and save my breath.

      That is how I feel in this very moment. I will leave you to your beliefs, and spare myself the pointless wear and tear on my fingers. Cheers!

  3. For all the heat around this birth control mandate, there is a good public policy rationale for it, aside from notions of convenient sex, or any other framing.

    Children are expensive. Unwanted children are more likely to encounter the criminal justice system, and child protective services. Reducing the number of unwanted children will improve the general welfare.

    • More than that, children are *people*. The decision on whether or not to create another brand-new living person seems rather unlike any other decision one can make.

  4. Missing the point entirely, pretentiousness notwithstanding.

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