For many women, serving in the military doesn't just mean serving their country. The irregular schedules and months-long deployments can be a significant challenge to using birth control.
This is a problem when military health clinics only stock certain contraceptives, or tell women service members (wrongly) that they’re not eligible for a long-acting contraceptive like an IUD if they haven’t had children yet.
Now, a nonprofit pharmaceutical company wants to change all that — and is offering the military a unique financial deal if its clinics get on board.
Liletta is an intrauterine device (IUD) — and IUDs are one of the most effective contraceptives on the market. Once inserted, IUDs will prevent pregnancy for at least three years.
Liletta is usually expensive; it has a sticker price of $625. But its manufacturers announced Monday that it will offer the device for $55 to military treatment facilities — similar to the $50 price the companies already offer public health clinics.
"A number of studies suggest that a third of servicewomen can't get their preferred birth control method before they're deployed," says Jessica Grossman, chief executive of Medicines360, which manufactures Liletta. "A long-acting, reversible contraceptive might be particularly of interest to women in these situations."
Recent studies have documented difficulties women service members experience accessing contraceptives, especially while deployed. One study found that four in 10 women had difficulty accessing their contraceptive of choice while deployed — and military women have a higher rate of unintended pregnancy than the civilian population.
A standard pack of birth control pills only lasts for a month and relies on the woman taking her medication each day, at a specific time — a task that could prove impossible for women on the front lines. IUDs, on the other hand, last for years without any action on the part of the woman.
But not all military treatment centers stock the devices, and some women report facing obstacles trying to get one. A cheaper IUD might remove one of the obstacles.
"You have to have a child to have an IUD": servicewomen report obstacles accessing contraceptives
In 2013, researchers Kate Grindlay and Daniel Grossman interviewed 281 recently deployed women service members to understand how they used contraceptives.
Some report that birth control is almost treated as a necessity for deploying women, as the military aims to prevent pregnancy for their deployed service members. "They made very sure that we could have birth control before the deployment," one Iraq war veteran told the researchers. "VERY SURE."
Many others experienced obstacles; one-third said they didn't feel like they had access to their contraceptive of choice before deploying.
This seemed to be especially true for IUDs. Multiple women reported requesting the device, but being told that it wasn't appropriate for women who have never given birth. The idea that women must have children before getting an IUD is a myth, and one that circulates widely in the civilian world as well.
"I can't get sterilized since I don't have children, and I can't get an IUD since I haven't had a child," one women who served in the Navy told the researchers. Another woman, who served with the Army in Afghanistan in 2010, recounted, "[I] wanted to change from Yaz pills to NuvaRing [or] an IUD, but NuvaRing has to be refrigerated and [they said] you have to have a child to have an IUD."
Military health insurance does cover all FDA-approved contraceptives, but treatment facilities aren't required to stock all options. There are 740 of these clinics, scattered across the United States, and each facility decides which types of birth control to make available to patients.
"Our understanding is that it varies from base to base, but it's actually really hard to even get data on what women have access to," says Maggie Jo Buchanan, associate director for women's health at the Center for American Progress, which published an extensive report on the issue last year.
IUDs can be especially challenging for clinics to keep in stock. They can be expensive; Liletta, for example, costs $625 before any discounts. Doctors need training in how to insert the device, too.
Buchanan says that IUDs "can be a great choice when you're traveling all over the place and when you're in conditions where it's hard to take a pill at the same time of day, or an environment where the patch might fall off."
But right now, access to IUDs isn't guaranteed.
Will a $575 discount change how military women use birth control?
Medicines360 is a nonprofit pharmaceutical company — which can sound like an oxymoron in an era of sky-high drug prices. It launched in 2009 with a unique mission: making the best type of birth control financially accessible (this BusinessWeek story is a fascinating look into its launch — and Warren Buffet's surprising role).
"One of the big barriers to access is the high up-front cost," says Grossman, noting that IUDs typically cost between $300 and $600. "We started with the sole purpose of developing a low-cost but high-quality IUD."
Medicines360 brought Liletta to market in 2015 in partnership with Allergan, a larger pharmaceutical company. The device cost $625 for private clinics, although discounts for bulk orders were available. The real deal was for public clinics, who could purchase the device for just $50.
"We're definitely trying to keep our lights on, but also not making any profit on the devices at that price point," Grossman says.
Liletta has sold 75,000 devices since its launch last April. Half of them have gone to public clinics. That's unusual: Drug companies typically focus their marketing efforts on private clinics that can pay higher prices.
This year, the company began exploring whether a similar discount would be possible for military treatment facilities.
"We were finding that military treatment facilities, like public health clinics, also have difficulty stocking IUDs given their costs," Grossman says. "We wanted to provide this to women who are serving."
The big test: what types of birth control the military wants to buy
The Liletta offer isn't a partnership with the American military; treatment centers will still get to pick and choose what type of contraceptives they offer. It will be up to those hundreds of facilities to decide whether the steep discount is enough enticement to stock a new type of birth control.
"As quickly as we can, and as broadly as we can, we'll be trying to make military treatment facilities aware of this option," says Aimee Lenar, vice president for women's health at Allergan. "We've spoken to a number, and hopefully with this price point, it will work."
Buchanan, at the Center for American Progress, says that in her work, price hasn't been the primary obstacle to IUD access among women service members. Instead, she and other researchers have heard of women encountering myths about the device as a big obstacle — like the idea that they need to have given birth to use one.
Still, any step to make the device more accessible, she says, is a step in the right direction — and easier financial access could cause providers to take a second look at the research around IUDs.
"Any efforts to make contraceptives more affordable is welcome news," Buchanan says.