The IUD is a great birth control method and yet, many physicians don’t prescribe them. Why? Because of money.
On the heels of a recent blog I posted about the IUD, this months’ issue of OBG Management published a letter to the editor from a gynecologist in private practice who stated that physicians aren’t paid enough to insert IUDs and that’s why it’s not readily prescribed. She goes on to say that the cost of purchasing an IUD by a provider is more than what the insurance company pays for the procedure. Thus, physicians are not motivated to prescribe and insert IUDs because the procedure is “bundled” or included in the price of a post partum visit.
An IUD is part of a classification of birth control methods called “long-acting reversible contraception” (aka LARC). Included in this category are implants (such as Implanon®) that are inserted under the skin that release hormones which prevent pregnancies. Implanon can remain under the skin for three years; the IUD-hormone releasing device (Mirena®) can remain for five years and the Paragard® IUD can remain for ten. These methods are highly effective with a less than 1% failure rate and are a great alternative to permanent sterilization for women who are not quite ready to be permanently sterilized but are clear that they want a break before getting pregnant again. Unfortunately, they are extremely expensive and require that the physician or clinician purchase them in advance. A clinician is not going to spend $500 to $700 to purchase an IUD and only get reimbursed $100 to $200 by the insurance company. The irony is the same brands of IUDs cost 50% less in foreign countries.
The hypocrisy is maddening. On one hand, policy makers rattle off alarming numbers that half of all pregnancies in the U.S. are unplanned and yet, insurance companies “nickel-and-dime” healthcare providers regarding the insertion of IUDs. You can’t have it both ways. Either lower the wholesale cost of the IUD so that healthcare providers can pay for it or reimburse them at a competitive rate. American women should not have to suffer as a result of greed.