Idaho is among a minority of states with Medicaid programs that have agreed to pay for Norplant, the new five-year contraceptive implanted under a woman's skin.
According to the June issue of State Legislatures, the magazine of the National Conference of State Legislatures, only 12 states' Medicaid programs have approved payment of claims for Norplant.But no Idaho claims were paid during the first three months of 1991 and the only physician known by Planned Parenthood and other health organizations to be offering it in the Boise area was unaware the state was covering the drug and implant procedure.
"That's news to me," Dr. Richard Roberge, an obstetrician-gynecologist at the Caldwell Women's Clinic, said Tuesday.
Mary Keltz, a spokeswoman for the Idaho Department of Health and Welfare, said the agency's rules require it to pay Medicaid claims for contraceptives approved by the Food and Drug Administration. Federal rules also mandate that the state pay family planning claims submitted by Medicaid recipients.
Roberge, who has performed two Norplant procedures since the drug was approved by the FDA in December, called that good news for low-income women who previously were limited to short-term or permanent birth control options.
"If you consider that the Medicaid patients deserve to have the same number of procedures available to them as anybody else, then it's a positive step," he said.
Keltz said Idaho's maximum Medicaid reimbursement for Norplant is $427, including $385 for the drug itself and $42 for the implant procedure. Over the five-year life of Norplant, that compares favorably with the most commonly used oral contraceptives costing $225 to $280 a year.
Even the cheapest type goes for about $100 a year, Keltz said, or $73 more than the maximum Norplant reimbursement over five years.
"We do not know if the feds have done a cost-effectiveness analysis and we have not done one," she said. "However, on the face of it we believe that it is cost-effective."
Roberge said a single Norplant treatment, which includes six flexible capsules implanted under the skin of the upper arm to continuously release a low dose of progestin, costs physicians $367 from the manufacturer.