The price of contraceptives depends on who's buying

April 15, 1994|By Arthur Caplan

IF YOU are a woman and thinking about using birth control, do you know what costs $21.97, $29.50 or $18.30 -- depending on who is paying?

If you said a single shot of Depo-Provera, I'd be flabbergasted, but you would be right.

But whether or not you solved this puzzle, the different prices being charged for this newly available contraceptive reveal a lot about some of the problems facing women who want to use this or other long-term forms of birth control.

Depo-Provera is a contraceptive for women that is taken by injection. A single shot prevents conception for about three months. Depo, which is made by Upjohn, the huge Michigan-based pharmaceutical company, has been in use in many nations for years.

The good news is that it was recently approved by the FDA as a contraceptive in the United States. The bad news is that the cost makes it hard or impossible for some women in America to choose to use it.

The price of long-acting contraceptives was the subject of a recent hearing of the House Small Business and Regulation Subcommittee chaired by Rep. Ron Wyden, a feisty Oregon Democrat who is rapidly acquiring a reputation as a tough watchdog over the health-care industry.

During the hearing, the over-the-counter, retail price for a shot of Depo-Provera was put at $29.50. But the Department of Defense and the Department of Veterans Affairs, which buy in bulk and have powerful friends in Congress and the White House, pay only $18.30. Meanwhile, $21.97 is the amount that some Medicaid programs and Planned Parenthood are charging for Depo-Provera.

Depo-Provera is not the only contraceptive that has a different price depending upon who wants to buy it.

Norplant, the implantable, long-lasting contraceptive made by Wyeth-Ayerst that consists of small sticks put just under the skin in a woman's arm, retails for around $365 per kit.

But Norplant is often sold for less. Some state and private programs have gotten low enough prices on Norplant to be able to give it out for only the cost of the minor surgery needed to implant it.

Long-lasting contraceptives are hardly the only pharmaceutical products being sold at different prices to different purchasers in the health-care field.

Anyone working in the real world of medical sales will tell you that the prices of drugs and medical devices vary from purchaser to purchaser depending upon how much product is being bought, how sharp the purchaser is in cutting a good deal and how competitive the market is in a particular region.

The free market can work to keep prices low if purchasers are on their toes and there is real competition among sellers to capture their share of the market. But that is precisely what is missing in the field of long-acting contraception. There are hardly any drug companies in the contraception business. Upjohn and Wyeth have the long-term field to themselves.

In fact, it is not clear that private industry alone would have invented Depo and Norplant. Norplant was developed with the financial help of the Population Council.

And a lot of the testing of Depo-Provera in poor nations was done with the help of money from the World Health Organization and private foundations.

Manufacturers call the pricing shots when it comes to long-acting forms of birth control because there are so few companies in this business.

Representative Wyden got it right when he said during the hearing that "people in the Third World have more contraceptive choices than Americans do" and the only way to fix that is to for the federal government "to promote more competition" by investing money in more contraceptive research.

The president of the National Family Planning and Reproductive Health Association, Judith De Sarno, who testified at the March 18 hearing, agreed. She said that the federal government ought to think about providing grants to smaller pharmaceutical companies to encourage them to enter the long-term contraception market.

De Sarno also suggested that every federal agency, including Medicaid, develop plans for bulk purchasing to assure that women who want to use these birth control methods can get them at the lowest price.

These are good ideas. It makes little sense for American women to pay taxes to develop contraceptives which then are not available to all who want them because their price is more than an individual purchaser can afford.

Until such time as the long-term contraceptive field becomes competitive with respect to price, government officials must try to work with contraceptive manufacturers to make sure that prices, profits and availability remain in a balance that gives women as much choice as medical technology permits.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota Medical School.

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