It can still be incredibly difficult for U.S. women to get access to the right birth control—but last week, President Biden issued an executive order that could finally make a difference.
Biden issued the wide-ranging order, which includes several directives to protect and expand access to contraception, almost exactly one year after the Supreme Court overturned the constitutional right to an abortion. As part of his mandates, the president instructed federal agencies to address widespread insurance-industry practices that prevent women from accessing their preferred birth control. The order was issued two months after Fortune published an investigation into those problems.
Private insurance companies regularly refuse to fully cover some contraceptives, despite being required to do so by the Affordable Care Act, Fortune’s April investigation found. As a result, many women are unable to afford the birth control they want (and their medical providers prescribe), while the companies that develop and sell new kinds of contraceptives have struggled to stay in business.
On Friday, Biden specifically ordered federal agencies to address these problems, by considering issuing "new guidance” to ensure that private insurers fully cover women’s contraception. Such guidance could also “streamline the process for obtaining care women need and want,” the White House said. (White House advisers also acknowledged "some of the reports out there about [insurers’] failure to comply” with the Affordable Care Act, Stat News reported on Friday.)
These pervasive insurance coverage problems have contributed to a worsening reproductive health crisis: Almost half of all U.S. pregnancies are unplanned, according to the Guttmacher Institute. Now that the Supreme Court has overturned Roe v. Wade, millions of women with such unintended pregnancies no longer have access to abortions and adequate reproductive health care.
Biden’s executive order did not discuss a specific deadline for federal agencies to take new action. But reproductive-health advocates and industry executives alike celebrated the White House’s action, calling it a promising step in the right direction.
“I’m really hopeful,” Mara Gandal-Powers, director of birth control access and senior counsel for the National Women’s Law Center, tells Fortune. “It certainly indicates that this is really high priority for the President—and I do think that the agencies listen when these kinds of things come out.”
Executives at Agile Therapeutics, which makes a new kind of contraceptive patch called Twirla, also said they were heartened by the president’s order. They hope the federal agencies will release new guidance as soon as this summer, in what they call a best-case scenario—or, in a worst-case scenario, sometime next year.
Agile spent more than a decade, and invested about $250 million, to get regulatory approval for Twirla—at a time when many larger and better-funded pharmaceutical companies have stopped investing in women's health. But after the company launched its product in 2020, it discovered that insurance providers would routinely reject doctors’ prescriptions for it. In 2022, insurers refused to fully cover 55% of the prescriptions doctors wrote for Twirla, according to Agile—which lost more than $25 million last year.
In the past few months, Agile has raised money and continued to increase sales, but it’s still fighting insurers to get its product covered. (The company reported a net loss of $5.4 million for the first quarter of 2023.) Now CEO Al Altomari is hoping that the White House’s intervention will help him get back to his core business of selling birth control, without all the expensive insurance wrangling.
“My company’s fighting for its life right now. A couple of us are,” Altomari says. “I wanted it last year—but this could be really good.”
