Many Alaskans have to travel for health care needs, including contraceptives. They aren’t always easy to get, and sometimes they aren’t available as long-term prescriptions — which can lead to inconsistent birth control use. Telehealth companies and state lawmakers are trying to change that.
Recent polling suggests that a majority of Alaskans support easy access to contraceptives. But that doesn’t necessarily mean it’s easy for patients to get them — especially in rural areas.
Wrangell Island’s state public health office is only open for a few days every month or two. It closed in 2016 after cuts to the state budget forced the department to shutter offices in Wrangell and Haines.
“At this point, since there’s not a full-time health nurse that’s located in Wrangell,” says public health nurse Erin Michael. She serves Wrangell, Petersburg, Point Protection and Point Baker. “That means that they haven’t been able to bring over the nurse practitioner like they had previously, when we had a full-time staffed health center there.”
Public Health provides a variety of services including immunizations, STD testing, and birth control. But without a nurse practitioner in town, the office can’t prescribe birth control. For Wrangell residents, that can mean a plane or ferry ride to get a prescription.
Wrangell has a tribal clinic run by the Southeast Alaska Regional Health Consortium that provides birth control. But even with sliding scales for lower-income patients, out-of-pocket costs for some birth control methods can range into the hundreds or even thousands of dollars.
In some places, telehealth providers like the Pill Club have begun moving in to try and cover the gaps. That’s a digital healthcare provider focused on contraceptives that expanded to Alaska earlier this year.
Stephanie Swartz is its senior director of policy and public affairs.
“Telehealth really has the potential and the promise to reach people who have historically struggled to receive the care that they deserve,” Swartz says, “Whether that’s because providers and centers are far away or because they felt like providers just have not paid attention to their needs and their personal conditions.”
Insurers have to cover the cost of contraceptives, although bureaucratic technicalities can still make it difficult for women to find birth control that works for them.
“Even if people aren’t covered by insurance, we also work to keep our prices as low as $7 a month,” Swartz said.
Companies like the Pill Club also aim to improve access. The average wait time for an OBGYN is more than 20 days in the U.S., and many small communities, like Wrangell, don’t have one.
“If you have an urgent need or if you have lost a pill pack, that is a real barrier to getting timely care that you need,” Swartz said.
She says there are also benefits to communities when more have easy access to contraceptives.
“History has shown that access to birth control leads to many follow-on benefits for people who need birth control, whether that’s the opportunity to complete schooling to fulfill a career of their choice, and to have better control over the when, how and whether they want to have a family,” Swartz said.
In the state legislature, West Anchorage Democratic Rep. Matt Claman has also been working to expand access to contraceptives. For the last few legislative sessions, he’s sponsored a bill that would, among other things, require insurance companies and state entities to cover up to a year’s worth of birth control at a time.
“It’s not just people in rural jobs and working out on the water, but it’s also people in rural communities that might not even have a drugstore in their community. And they’re relying on mail-order pharmacies to get their prescriptions filled,” Claman said. “All those all those folks that, if you have a slight change in your schedule and you run out of your prescription birth control, you actually then lose the benefits of having the medication.”
The Alaska Public Health Association has supported previous versions of the bill. The Alaska Network On Domestic Violence and Sexual Assault has weighed in, too. Supporters there see a legal mandate to provide longer-term prescriptions to birth control as a way to prevent domestic violence like contraceptive coercion or pregnancy pressure.
There’s been some opposition to the bill from groups who see the bill’s coverage of emergency contraceptives as coverage of abortions.
“We actually had an analysis from the Department of Health and Human Services that showed that it actually would save millions of dollars a year to the state in unwanted pregnancies,” Claman said. “These aren’t abortions, these are people that want to be on contraception, and the contraceptive works. There’s no pregnancy.”
The bill – HB58 – hasn’t moved since last April, but Claman says he’s optimistic.
“So many Alaskans care very deeply about this issue and believe it’s a really positive step to really improve access to health care for all Alaskans,” Claman said. “We’re optimistic that we will one day pass the legislation and are not giving up.”
While the legislative expansion of contraceptive access is stalled for now, telehealth providers like the Pill Club, local clinics, and Public Health still provide access to a variety of birth control methods. And even when public health centers aren’t open, many, including Wrangell’s Public Health office, keep free condoms outside the door.