Brief State Contraception Policies

Contraception, also known as birth control, is the use of medicines, devices or surgery to prevent pregnancy. Access to a range of contraceptive methods may help women and their partners to plan and space their births. Contraception can also help reduce unplanned pregnancy. Research shows planning pregnancies leads to positive health, social and economic outcomes for women, families and society.  

Several factors may play a role in a person’s decision on contraceptive methods, including: 

• Personal preferences such as ease and comfort with mode of use and preference for a hormonal or nonhormonal method.  
• Medical considerations such as whether the method protects against sexually transmitted diseases (STDs) and potential side effects.  
• Whether the method can be used without involving the user’s sexual partner.  
• Structural factors such as immediate and ongoing costs, geographic access to a provider and the ability to begin or stop use without seeing a provider. 

Approximately 65% of females 14 to 49 currently use contraception. The most common contraceptive methods currently used are female sterilization (18.1%), oral contraceptive pills (14.0%), long-acting reversible contraceptives (LARCs) (10.4%) and the male condom (8.4%).  

The Affordable Care Act (ACA) requires all non-grandfathered group health and individual health insurance plans to cover certain preventive health services with no cost sharing, e.g., copayment, coinsurance or deductible. This includes coverage for all 18 contraceptive methods approved by the U.S. Food and Drug Administration (FDA). There are religious exemptions and accommodations for certain employers.   

Common Forms of Contraception

Contraception methods vary in efficacy. Female sterilization, hormonal intrauterine devices (IUDs) and implantable rods all have efficacy rates of less than one pregnancy per 100 women. Patches, contraceptive rings and oral contraceptives have efficacy rates of nine pregnancies per 100 women. The IUD and implantable rod must be inserted by a health care professional and last up to five years and three years, respectively. The patch and ring each last three weeks and then are removed for the fourth week. Users may have preferences based on these differences. 

Emergency Contraception 

Emergency contraception is a form of backup birth control that can be used up to several days after unprotected intercourse or contraceptive failure, e.g., condom breaks, and still prevent a pregnancy. Emergency contraception is not intended to be used as a regular form of birth control, and emergency contraception methods are not the same as medications used to end an early pregnancy. The ACA requires coverage for two forms of emergency contraception if they are prescribed by a health care provider. Pharmacies may also offer over-the-counter emergency contraception.  

State Contraceptive Laws 

States expand upon federal requirements to address access to contraception through various policy levers, including insurance requirements, scope of practice modifications for advanced practice clinicians and pharmacists and other provider requirements. 

• At least 30 states and the District of Columbia require insurers that cover prescription drugs to provide coverage of FDA-approved prescription contraceptive drugs and devices: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, West Virginia, Wisconsin. 
• At least 12 states and the District of Columbia require coverage of certain methods received over the counter, e.g., oral contraceptives or male condoms); the insurer may still require the enrollee to obtain a prescription: California, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Nevada, New Jersey, New Mexico, New York, Oregon, Washington. 
• At least 26 states and the District of Columbia require insurers to increase the number of months (mostly commonly to 12 months) for which they cover prescription contraceptives at one time: California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Louisiana, Maine, Maryland, Massachusetts, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia. 
• At least 13 states and the District of Columbia require hospital emergency rooms to provide emergency contraception information to sexual assault victims and to dispense upon request: California, Connecticut, Hawaii, Illinois, Louisiana Massachusetts, Minnesota, Mississippi, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Utah, Washington, Wisconsin. Four states require emergency rooms to only provide information: Arizona, Colorado, Texas and Virginia. South Carolina requires emergency rooms to dispense emergency contraception upon request.
• At least 25 states and the District of Columbia allow pharmacists to provide contraceptive care, e.g., contraceptive counseling and prescribing and administering hormonal contraceptives such as oral contraceptives or injectable contraceptive options: California, Colorado, Connecticut, Hawaii, Idaho, Illinois, Indiana, Maine, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia. Five states have enacted pharmacy access laws but have not set regulations: Arizona, Arkansas, Delaware, Nevada, New Hampshire.
• Seven states permit pharmacists to dispense emergency contraception without a prescription: California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Washington). 
• Nine states and the District of Columbia prohibit restrictions and delays by insurers that restrict access to contraceptives: California, Delaware, Illinois, Nevada, New Mexico, New York, Oregon, Vermont, Washington.  

Several states have enacted unique contraception laws. For instance: 

• Maine permits pharmacies to apply for a license to sell nonprescription medication, including emergency contraception, through vending machines. 
• West Virginia requires a pharmacist who dispenses self-administered hormonal contraceptive to provide the patient with information on the effectiveness and availability of IUDs and implants. 
• Virginia expanded the ability of pharmacists, as well as pharmacy technicians being supervised by a pharmacist, to distribute contraceptives to patients through telehealth. 
• South Carolina permits pharmacists to administer injectable hormonal contraceptives.