When Does a Rubber Cup Require a Prescription? When It May Help Prevent Pregnancy
FDA says silicone cup inserted in the vagina to block sperm cannot be sold over-the-counter.

"Are you a fan of the retro-inspired? Is your vagina?" asks Marie Lodi at Jezebel (in a post that reads suspiciously like sponsored content). The reason she's asking is the re-emergence of a once-popular birth control method called the diaphragm—a shallow, silicone cup that's inserted up against a woman's cervix before sex to block any sperm from passing. And the reason I'm writing about diaphragms here at Reason? Because the U.S. Food and Drug Administration (FDA) thinks purchasing these pieces of rubber should require a prescription.
Keep in mind the diaphragm contains no hormones or medication of any kind. It is literally just a fucking cup, albeit one designed to be inserted in the vagina to prevent pregnancy. In the old days, requiring a prescription for diaphragms made some sense, as they came in different sizes and women needed to be fitted by a doctor. But the new diaphragm, sold under the brand name Caya, is a one-size-fits-all affair.
Even the usually-regulation-happy commenters at Jezebel seemed perplexed and miffed by this situation. "It's a plastic cup. Why would anyone need a prescription for that?" wondered Wendi Muse. "So ridiculous."
"This is basically a DivaCup for sperm refraction," wrote another commenter, referring to the silicone menstrual cups sold—prescription free—as an alternative to tampons. "I don't get why I can buy a DivaCup at Whole Foods, but I can't pick up one of these babies."
"Come. The. Fuck. On," commented yet another. "Why is this by prescription only?" It's not like we haven't been shoving tampons into our hoo-has forever. I'm pretty sure we could figure this out."
But, of course, the diaphragm's prescription-only status has nothing to do with what women actually are capable of and/or need. Gynecologists, women's health centers, and Caya's manufacturers can all make more money if the device requires a prescription. Democrats don't mind it being prescription only, because then they can crow about how they've helped women get "free" diaphragms through Obamacare. And social conservatives tend to balk at any form of birth-control being made more easily accessible. Plus, the FDA will regulate anything it can get away with regulating. It may make no sense for Caya to be prescription only, but it's not surprising, unfortunately.
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Hopefully the NYT will do some investigating and find an egregious loophole to the law that allows just any unregistered, untrained chimp to purchase such a device.
Until then, there's always anal.
Is there, though?
Nah, all things regulation good.
Exception: family planning.
So...the executive branch has been in Democratic hands for 6 years, many of them with a Democratic Congress, and in any case the President has made clear he can make Congress irrelevant by suspending laws he doesn't like. And when Republicans propose to make birth control over the counter, Democrats oppose the idea and progressives write op-eds about how awful the Republicans are to suggest it.
And in these circumstances, we're still going to blame the SoCons for the prescription-only status of this device?
Maybe the SoCons are pulling the levers secretly behind the scenes, like Opus Dei and the Jews?
And in these circumstances, we're still going to blame the SoCons for the prescription-only status of this device?
Well, if by "blame" you mean "mention as an afterthought after several other interest groups, and listed somewhat blandly as a group that would 'tend' to oppose reversing its status" then sure, I guess they're being blamed.
But by all means, don't let what the article actually says get in the way of your persecution complex.
If by "persecuted" you mean "annoyed by foolish statements," then yes, I'm persecuted.
Look again at the passage I'm critiquing. It gives a list of reasons for the prescription-only policy:
"But, of course, the diaphragm's prescription-only status has nothing to do with what women actually are capable of and/or need. Gynecologists, women's health centers, and Caya's manufacturers can all make more money if the device requires a prescription. Democrats don't mind it being prescription only, because then they can crow about how they've helped women get "free" diaphragms through Obamacare. *And social conservatives tend to balk at any form of birth-control being made more easily accessible. [EMPHASIS ADDED] Plus, the FDA will regulate anything it can get away with regulating."
Did you see the part I highlighted? It's one of several reasons why the diaphragm is prescription only.
Because, I suppose, the SoCons hexed the FDA and turned it into a panel of Cotton Mathers. Six years into the Obama adminitration.
And might I add, who is proposing OTC status for contraceptives nowadays? Reactionary Repubs like Jindal and others.
And might I add, who is proposing OTC status for contraceptives nowadays? Reactionary Repubs like Jindal and others.
And it's your position that they are proposing this after a careful and measured analysis of what would be best for women's health, and not, say, to stick a thumb in the Democrats' eye vis-a-vis Obamacare? And can I interest you in an exciting investment opportunity concerning a certain bridge in Brooklyn?
What on earth are you talking about? The voices in your head sure say some weird things, the problem is that you then attribute these things to me.
No, I said Jindal and the others wanted contraception to be OTC. I didn't say *why* the supported this, only *that* they supported it.
Oregon opts to dramatically expand women's birth control access
OK, I thought I was talking about *federal* policy, but if you're going to argue with the SoCons in your head who were talking about state-level policy...I notice that those state-level bills *passed.*
Squirm harder, Eddie.
Oh, sugarfree, don't get your rape-tentacles in a twist, it's actually very simple, almost as simple as you are. And a whole less convoluted than the plots of your stories.
ENB analyzed the causes of *the FDA regulation* - she blamed the SoCons.
I questioned their guilt where the FDA regulations were concerned.
What on earth are you talking about? The voices in your head sure say some weird things, the problem is that you then attribute these things to me.
No, I said Jindal and the others wanted contraception to be OTC. I didn't say *why* the supported this, only *that* they supported it.
I'm sorry for overestimating your ability to understand this. Let me break it down:
1. ENB says "social conservatives tend to balk at any form of birth-control being made more easily accessible"
2. You characterize this sentiment as "blaming" social conservatives for birth control's perscription-only status.
3. You further imply that this is a mischaracterization of the social conservatives' agenda by nothing that some conservatives have proposed making birth conrol OTC. If the conservatives are doing this because they earnestly believe in the social benefits of making it easier for women to acquire birth control, you have a point.
4. However if, as I pointed out, the conservatives are making that proposal based not on ideological principal, but to score political points against Democrats vis-a-vis Obamacare, then ENB's original statement is correct: the conservative tendency is to oppose increased access to birth control, but that tendency can be overridden by political concerns, such as in this instance.
Well, points 3 and 4 are certainly one way to read it, but I was talking about what people in the political arena were actually doing. And I certainly wasn't ruling the possibility that politicians were acting from political motives.
So I'll cheerfully stipulate, for present purposes, that Jindal and the others advocate OTC birth control, while secretly regretting it.
I'm talking about what *some* SoCons are *doing,* not what they're thinking.
And I'm talking about what Dems and Progs are doing *without the need to worry about SoCon opposition, because they run the executive branch.*
Yeah. What PA said. Are most socons agitating for it to be non-prescription?
I don't think "blaming the socons" is quite the way to characterize what she wrote.
"Are most socons agitating for it to be non-prescription?"
I don't see how that's relevant, since the SoCons aren't running the Obama administration or its FDA.
PA seems to agree that *some* SoCons support OTC status, he simply denies that their motives are pure enough.
It's relevant because it answers the question of whether socons, as a class, are for it or against it.
ENB lists several groups who contribute to this being prescription only who are almost certainly Democratic constituents and donors and then mentions one grouping of conservatives. That can hardly be called "blaming socons". It is clear in the article that they are not the main driving force behind this.
All right, all right, she blames lots of Dem interest groups.
I've simply become accustomed to what some here call "social signalling" on the part of Reason writers. So when I saw SoCons in a list of culprits for the FDA regulation I was like "WTF? What influence to the SoCons have on the Obama administration?"
Well, if it wasn't persciptipn, then insurance may not pay for it!
ENB, don't you get that making people ask for permission to get things make them more accessible ?
Not paying for things is the ultimate freedom!
Restriction Is Access!
Freedom Is Slavery!
SoCons Have Always Been At War With Women!
Jareth: Just let me rule you, and you can have everything that you want.I ask for so little. Just fear me, love me, do as I say and I will be your slave.
*le sigh*
*swoon*
*melt*
Does nobody remember the toxic shock syndrome!?!?!?!?
Great, now we'll need an Rx for a box of tampons.
That is almost what I titled this post
If you'd stop soaking them in vodka first, we wouldn't have to take them away from you.
Who's up for Diva Cup shots, bitches?
That comment may have been worse than any of your Hillary Clinton smutfic.
Don't be a sissy, JB. I wiped them out first.
There's a Bloody Mary joke in there, somewhere, trying to get out.
"What happens when you turn out the lights and say "Diva Cup" into the bathroom mirror five times?"
If you're paying for your own tampons then society has failed you.
The Case For Free Tampons
The cost of a product that half the world's population needs multiple times a day
"Dur, half population be women so they be on period, dur. Me think good."
I honestly think she's gotten dumber since having a child. Maybe her oxygen got cut off during delivery.
Our cycles must all be synced in a super nova menstruation.
"Dur, half population be women so they be on period, dur. Me think good."
RAYCISS!!!1!
I tell my wife everything she does could cause toxic shock syndrome... then she rolls her eyes.
She probably rolls her eyes at everything you say. Or are you new to marriage?
no. it's been 10 years. And it's ALMOST everything- there are, for instance, times when I agree with her that she doesn't roll them.
Does nobody remember the toxic shock syndrome!?!?!?!?
Who doesn't?
Gawker Commenters = legitimate source of policy analysis.
Hit & Run Commenters = vile, juvenile, blowhard scum.
(flexes bicep, feels the muscle, nods to self)
I can't help but wonder if there was some point, in the Before Time, when a bunch of us weren't being jackasses just for the sake of being jackasses.
You don't get to be the best by accepting mediocrity.
We need to redouble our efforts, men! Our output quota has been increased in the new 5 year plan!
I actually think it was worse before. I feel like I've grown up quite a bit in the last year, and I hardly ever say anything remotely juvenile.
I feel like I've grown up quite a bit in the last year, and I hardly ever say anything remotely juvenile.
Pfft, fag.
To be fair, the trolls shit all over the articles much less frequently, so there's no reason to stoop down to their level as much.
Honestly, I think Elizabeth was just surprised to see the stopped clock being right for once.
Oh shut up, Sug. When a writer says, "Even the statists thought this was too much state," clearly she's saying I FUCKING LOVE THE STATE AND ALL STATE-LOVERS.
I lost my Little Orphan Annie CJW decoder ring. I think it fell in the toilet. 🙁
CJW?
I'm gone for a week and we have new acronyms?
Cunt Justice Warrior?
Cup o' Jizz Whiners?
Can't Jam to Wham?
That one's not exactly new, I remember Bo using it at least a few months ago...
Bo was really just the avante-garde of the New, Englightened Libertarianism that constantly spits on their peers with smug disdain
That's why you need a doctor to properly fit it into your ass.
Is the duodenum the cervix of the ass?
Duodenum? I hardly know 'em?!
How should I know? Do I look like a member of a state-backed cartel to you?
I was just a ruminatin', little lady. Don't get your diaphragm in a twist.
I think there's a Dan Savage column talking about using using female condoms for buttsecks, but I can only find the one about using them for FFM threeways at the moment.
No link required.
The early female condoms were described as "crinkly" and "noisy" and men and women both said it was like having sex with a sandwich baggie.
See, you have to get the quart-sized baggies. Sandwich baggies tend to be more pint-sized..
Actually, I was just sad no one here has ever been quoted in H&R*
*outside of Subpoenas
(saddest sad face)
Not true. Our resident stalker posts our comments in Jezebel from time to time.
"They themselves will have a sad and require medication when they find out that you don't even know they are alive."
(sobs) Its true!
Oh wait, nvm, they think we actually care about their opinion.
Can't say much. We have guys that do the same for us.
What bizarre little man. The utterly prolific amount of commentary to the point that it seems that he has an almost ubiquitous presence in the social media sphere suggests someone living on disability checks.
Ugh. Ableism
" It is literally just a fucking cup, "
*narrows gaze*
Actually, I was thinking that line deserved a standing O.
I can't do it standing. Most women are too short.
Well my standing O face suffice?
I see what she did there!
Sounds like you need to lift more. That way you can hold them up.
Fucking comment's in the wrong place. I blame the squirrels. That was supposed to be a reply to Dark Lord's comment about most women being too short for a standing O.
Not that contraception, prescription or not, should even be an issue, because consensual sex is literally, like, rape, ok?
So keep that in mind next time you think you're seducing a willing partner: in actuality, she's fighting for her bodily integrity.
Sounds like somebody really needs to get laid.
Sounds like somebody who would immediately report a partner to the police.
This.
Holy Shit, I sampled the comments....and you didn't provide a trigger warning, you bastard.
So, why can't women use men as dildos? I'm pretty sure that's happened to me. And I'm OK with that.
Dildos are phallic and represent the patriarchy.
Part of the "PIV sex is rape" theory is that women do not in fact find sex pleasurable, and those who do have been traumatized. It is an inherently violent and painful thing for women to be penetrated.
i wonder how they explain the many girls who figure out how to penetrate themselves with inanimate objects well before they are ever threatened with an erect penis? I suppose they all must have been raped at an early age and are just blocking out the memories because of all the trauma.
It's not exactly easy to argue against. People do find all kinds of ways to "abuse" themselves.
That's your problem Nikki. You come here and rely on us to do all the hard work of abusing you.
But usually because they find pleasure in it. Which is kind of hard to reconcile with their thesis that no woman enjoys sex.
I briefly, briefly, dated a chick like this in college.
She was a fucking weirdo.
If one's introduction to sex were Japanese A/V films, that would seem like a theory with a high amount of face validity.
Wait 2013?!? Oh god, I thought that blog was written in the 90's and just kept getting circulated. I didn't realize idiots were still saying that.
The weirdest part of that is that it seems like they are also opposed to pregnancy and giving birth. I admit I didn't read much of it, but that certainly seems to be where the reasoning is leading. Do these people think that everyone should just sit around and wait to die, or what?
No apparently they believe birth is the only purpose of a vagina, and that using it for anything else is rape. No word on how you are supposed to give birth if you don't have sex first.
You've never heard of artificial insemination?
I hear it's a very new technology, while humans have been around for thousands and thousands of years.
At least in that little essay, and in some of the comments, it sounds like pregnancy and birth are all a part of the trauma and pain forced on women by men.
There are some pretty obvious ways to give birth without having sex first (though a man still needs to be involved in some way). But that doesn't eliminate the really painful parts.
Reading a few of the comments, it seems like these are some really sad, damaged women who have never had a good sexual experience and assume that their experience must be typical. They couldn't possibly be unusual or deficient in some way. Everyone else must be deceiving themselves.
They don't think they are typical, but they do think it's the other women who are the damaged ones.
Ah, the old false consciousness trick.
"If only you knew how unhappy you truly are, you could be a miserable shrew like me".
I think I feel sad for these people more than anything else. What a dreary life they must lead.
They are clinically insane Zeb. Batshit crazy.
Yeah. Literally exactly that. Which is why I find it sad. They will never really enjoy anything.
I think that lunacy is plagiarized from Andrea Dworkin(?) from a couple of decades ago. I remember my wife reading it to me on a long road trip. After she read that part of the book she sat there very quietly for a minute and then pronounced "What a bunch of horse shit" and tossed the book out of the car window.
She then gave me a blow job while I was driving.
Dworkin turns you on, eh?
"I'm pretty sure we could figure this out."
You sure, cus according to my wife, her sister once tried to put a BC pill in her snatch.
My brother-in-law fell for the, "The doctor said I can't get pregnant!" line, and now he has a second bundle of joy on the way. I figure after the first one, he stopped giving a damn.
did he stop giving a dental dam?
I wonder if he condoms this regulation, or whether he opposes it.
What (vas) deferens at this point t does it make?
*rimshot*
Actually the purpose of that post was to point out that all women are lying skanks, and to treat them as such at all times.
I see one has re-adjusted one's monocle.
I tip my top hat to you sir.
Is your sister a Democrat?
She's my SIL Eddie, and yes.
Well, I won't speak of her specifically, but I will say that the Democrats seem to have an...unfavorable view of the intelligence of their female constituents.
"I mean, they vote for *us,* how smart can they be?"
the only constituents whose intelligence the Dems seem to have much regard for are unionists and bankers.
Keeping the cup a scrip makes it subsidized-Affordable Care Act item almost exclusively.
Should be useful for war-on-women claptrap...no pun intended.
Oh, Elizabeth. We know the real reason.
Abortion?
::Claps slowly::
let's not forget the weed and mexican butt sex.
See? You're obsessed!
I knew it!
Is...is it because of gay marriage?
because the War on Women is really a conspiracy by Feminazis in some bizarro reverse-psychology political magic trick/slight-of-hand?
*i knew it*
actually, diaphrams* are pretty wack. Condoms FTW. Make the guy do the awkward!
(*i don't spell that with a G. also, i think Dick Trampoline is cooler)
Ass sex?
I think I'm confused what these things are for!
(in a post that reads suspiciously like sponsored content)
ENB would know. Writing sponsored content for a ladies' website was the previous rung on her career ladder.
Hey, she was paying her dues. You can't just start on the top of the ladder.
(by "top of the ladder" I mean Reason of course)
Republican War on Women!
This story is full of pussies.
And we're dicks. Arrogant, stupid dicks.
Except for that asshole Epi.
And the FDA are a bunch of assholes.
Not a good. Not a drug.
Of course it's monitored by te FDA. Because to government, words don't mean a fucking thing.
Food. Not a food.
Damn you, autocorrect.
"I found the diaphragm custard to be far too chewy."
...and had way too much protein...
as they came in different sizes and women needed to be fitted by a doctor.
Fucking credentialism. How much skill does it take to measure a damn cervix?
Hell, i'll park my van in an alley and do it for free.
couldn't there be some kind of spray on silicon that would fit everyone upon application with an aerosol delivery system?
Nobody wants a sandy vag.
then why do they fucking go to the beach in the first place!
(also, goddamnit! I know there's an E there... why didn't my fingers type it?!)
That's silica.
WITNESS ME!
And social conservatives tend to balk at any form of birth-control being made more easily accessible.
*rolls eyes*
Shouldn't there be a hyperlink there? Maybe try the recent story about no-notification IUD implanting in the elementary schools.
Funny how regulations are just TEH AWESOMEZ until they impact one of their personal hobby horses. Then it's OH NOEZ!11!!11!!!!! Of course, I'm sure they'll find some way blame men in general and conservative men specifically. Completely ignoring how their chocalate Jesus man crush has been in office for the last nearly 7 year and hasn't done jack shit.
Even the usually-regulation-happy commenters at Jezebel seemed perplexed and miffed by this situation.
That's because this regulation affects them. Nobody has every accused a Jezzie of being too principled.
Following this logic condoms would require scrips. Men would need an appointment with their doc to fit and learn how to apply.
Condoms should come with picture instructions, like Ikea furniture.
or at least a personal sizer at the drug store.
Can you imagine the vanity sizing... It'd be like pants sizes at Old Navy before it even gets started.
well, the smallest size will be a large. Like Papa Johns Pizza.
Measurements will be done in cm so that people can feel good about themselves.
It'll be like those Dr. Scholl's machines they have there. A big blue box that you go stick your cock in, and it spits out a condom of the "right" size for you.
well... what if one is in such as state that one no longer needs to condom after the sizing.
Is THAT why they want to increase the minimum wage- for cleaning these machines of the future?
Yep.
Condoms should come with picture instructions, like Ikea furniture.
I'll need a pack GL?NK condoms, please.
And get our prostates checked at the same time.
"checked"?
Unfortunately, it still won't reduce the number of Homeland Security goons at JFK.
"This is basically a DivaCup for sperm refraction,"
I don't think that would have the desired effect. Unless the fastest swimmers are the most fertile and there's a dispersion effect such that those sperm are the most refracted. TIR?
Reproductive optics isn't my field.
Maybe she meant interdiction.
(applause, judges await Russian who grudgingly gives a 7.8)
I wonder whether these things could be 3D printed. Guns and diaphragms, I think the ninnies would have a heart attack!
"The contraceptive effectiveness study showed the effectiveness is similar to that of a traditional, fitted diaphragm when both are used with a contraceptive gel."
Is spermicide not medication?
Spermicide is available easily over the counter, as are condoms coated with spermicide. That has nothing to do with this.
"Keep in mind the diaphragm contains no hormones or medication of any kind."
They don't. The recommendation is always to use two forms of birth control. Spermicide is already available separately and isn't being regulated in union with the diaphragm. The diaphragm is a simple barrier method.
Spermicidal lubricants are already easy to find OTC. They can be used without a barrier method which is better than just raw dogging at preventing pregnancy, but not a ton better.
raw dog is my go to on XM radio.
Who as a child *didn't* find their mom's diaphram* and use it as a trampoline for their action-figures to jump in the toilet? I mean, that's some seminal life-experience right there.
(*insert G if necessary)
I mean, that's some seminal life-experience right there.
*narrows gaze for Swiss*
look, the PUN section is further up in the comments. Let's keep them there where they belong.
My mom didn't have one. I tore up the tubes and wiring on my way out.
You really missed out. its like the best toddler-frisbee ever.
I would have just dropped it into the floor furnace like everything else. I would have filled the house with the warm and festive scent of burning rubber and hoo-ha juice.
I can see you grasping with your tiny hands- ripping everything as you exit- crying, "no other can share my experience! I am truly alone, truly singular. I am UNIQUE!"
All the toys are mine!
That's just what they tell you. The truth is, after seeiing you she stuck a coat hanger up her vag and tore her own tubes and wiring up to make sure she could never again birth something so hideous.
Meh. Worked out for me either way.
a W is a W, as they say.
OT: Since I don't think I'll be around for the PM Lynx, an article from Pat Buchanan showing the same thing that I was arguing yesterday RE the SoCons and Repubs in general coming to the conclusion that the country is "lost."
The Coming Era of Civil Disobedience
I don't know if you've noticed, but during election cycles, there is a conscious attempt by the media to convince people that they are nothing like their (OTHER PARTY)-voting peers.
I mean, not like they don't do it all the time... its just that they turn the knob to 11 when it comes time to fragment and categorize people.
America has been disuniting since the moment it united. We even fought a Civil War, if I remember my American history correctly. I wasn't alive for the experience, but the Vietnam War era wasn't very huggy.
It's just the typical gnashing of the teeth over our coming demise as a country.
And, Pat Buchanan, dude. Pat Buchanan.
Why don't they just sell the things and call them something else? Vibrator manufacturers and sellers of unregulated drugs seem to do well on that model. Call them toddler-frisbees (thanks to GILMORE).
Personal cervix massagers. Batteries not included.
THIS IS MY NEW FETISH!
"It is literally just a fucking cup,"
Nice double entendre.
Even the usually-regulation-happy commenters at Jezebel seemed perplexed and miffed by this situation.
Advocates For More Government Get More Government
And then for some reason aren't thrilled when "more government" directly impacts them. It's almost like they're a bunch of unprincipled pricks or something.
ENB,
You should've co-wrote this with another lady-journo and titled "Two girls & a cup".
Come on, that was too easy. (although I might not have been able to get past the work-filter)
So the Dems are micrmanaging these things so they can give them away.on other people's dimes?
That is about as convoluted a rationale as any I voild think of.
This has to be the wierdest baptists-and-bootleggers alliance ever.
I have an idea. Let's make is so that getting an abortion requires a prescription from a primary care physician, which can only be obtained through an ACA approved insurance plan.
That way Democrats can crow about giving people free abortions via Obamacare, and Republicans can celebrate making getting an abortion more costly, burdensome and annoying for women.
The War on Sperm, when will it ever end!
If it's really "up against the cervix" of the uterus, that's a cervical cap, not a diaphragm. Same idea, but smaller & able to be left on longer. A diaphragm should not be resting against the cervical os.
FDA does not try to regulate everything they can. For decades they fought against citizen petitions to have them regulate tobacco products as drugs, until one commissioner turned the situation around. They still show no interest in regulating recreational "drugs"; violations of the FFDCA are never piled onto the charges in narcotics cases.
The reason this new diaphragm is prescription-only must be that its purveyors got it licensed as a class 2 medical device, being substantially similar to predicate devices that were prescription-only. It would take someone to sponsor a new rule-making to get such a device marketed in interstate commerce as an OTC device. Or they could get a ruling that preventing pregnancy by barrier means does not affect the function of the body, and that pregnancy is not a disease. Either way is going to be costly.
The reason the FDA requires a prescription is because they can require one. Their purpose is the naked exercise of power. A few years ago, they actually undertook an undercover sting operation to take down a network of Amish farmers selling raw milk. If that doesn't expose them as fascists, I don't know what could make it more obvious.
OT:
Anyone in the market for a 3D printed diaphragm chipper?
Im making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.
This is what I do! .. http://www.homejobs20.cf
Conservatives balk at using abortion as a former of birth control, and at mandating that people whose religious convictions are opposed to paying for abortifacient drugs are forced to.
A little journalistic integrity does the soul good.
There, in a nutshell, do you have the reason for cost explosions in the US medical system.
99% of drugs and 80% of procedures should not require the services of a physician, or prescription, or "insurance" coverage.