Maryland is one of the first states in the country that will use Medicaid funds to pick up the tab for poor women who choose to use Norplant -- the new reversible, five-year contraceptive expected to be available here early next month.
"This is a significant breakthrough for women. We think it will be ++ cost effective and we have a very generous Medicaid program," Nelson J. Sabatini, the acting state health secretary, said yesterday.
Sabatini estimated that this year at least 110,000 Maryland child-bearing age women might be eligible for Medicaid reimbursement for the second most effective form of birth control after sterilization.
Under Medicaid, a state and federal program that shares the cost of health care for the poor, the cost of implanting the contraceptive will be $425 for each woman -- $350 for the device and another $75 for the doctor's fee, Sabatini said. The removal fee would be an additional $75 or more.
"In real dollars, the state Medicaid budget for this new fiscal year is going from $1.2 billion to $1.44 billion," Sabatini said. "We were interested in doing this. We look at Norplant as a prescription drug, and under our program we have made a decision to cover all Food and Drug Administration-approved prescription drugs designated as safe and effective.
"If you just look at Norplant in terms of dollars, it would be cost-effective. The delivery of a new baby under Medicaid costs $1,100 and that is certainly more than the cost of the Norplant."
The 11 other states that have approved Medicaid coverage for the contraceptives are Alaska, Delaware, Michigan, Montana, New Hampshire, New York, North Dakota, Pennsylvania, Utah, Washington and Wyoming, the spokesman said.
Norplant has just been released by Wyeth-Ayerst Laboratories in Philadelphia, the exclusive U.S. marketer of what is being hailed by some medical experts as "the most revolutionary development in the history of birth control since the Pill was introduced in 1960."
On March 18, Planned Parenthood of Maryland will begin training Baltimore-area physicians and other health-care professionals in Norplant counseling, insertion, monitoring and removal.
The training session for physicians and others will be held at the Towson Quality Inn, sponsored by Planned Parenthood and the Association of Reproductive Health Professionals. Co-sponsors are the department of obstetrics and gynecology of the Francis Scott Key Medical Center and the state health department's office of maternal health and family planning.
Planned Parenthood expects to serve its first Norplant patient within a month, according to Dr. Doris Tirado, the group's medical director.
Norplant consists of six match- stick-sized tubes that are inserted just beneath the skin on a woman's upper arm. The tubes release a synthetic hormone called Levonorgestrel that suppresses ovulation. The safe contraceptive has been tested on an estimated 55,000 women in more than 40 countries over a 20-year period.
According to a Wyeth-Ayerst spokesman, the cost of inserting Norplant for the average consumer will range between $500 and $700, depending on the physician.
Immediately upon approval of Norplant by the FDA a couple of months ago, Sabatini said, a bulletin was sent to several thousand doctors who treat Medicaid patients advising them that the new contraceptive was now covered by Medicaid.
Women who are eligible for Medicaid and interested in Norplant should first consult their doctors, most of whom are in hospital or community clinics, to see if there is any medical reason that they should not use the long-term contraceptive device, Sabatini said. If cleared, they would obtain the contraceptive by presenting their Medicaid card at the clinics they attend.
To be eligible for Medicaid, a person has to be "very poor," Sabatini explained. For example, a single woman would have to have an income of $320 a month or less; a family of two, an income of $380 a month or less; and a family of four, $500 a month or less. The average Medicaid family includes three people per household, he said.