Lady Business: The serious (enraging, dramatic, broken) business of birth control

Hello, and welcome to Lady Business, a newsletter about women, the business world, and all the ways they overlap. You can sign up for Lady Business and read previous issues here. This is the 146th issue, published April 16, 2023.

Pretty Bad, and Just Rampant

I’ve spent the last couple of months working on a new feature I’m both proud of and enraged by, featuring:

–A complicated female CEO running a failing women’s health company, and all the reasons–internal and systemic–her company is on the brink of bankruptcy.

–A problem facing every single person who can get pregnant (roughly 73 million U.S. women of reproductive age)–and all the people affected by their pregnancies. So, everyone.

–The most “lady business” topic of all–reproductive health care–and how big insurance companies, big pharma companies, and big investors think that 51% of the population isn’t worth spending money on. 

–An investigation into how our broken health care system functions. Or doesn’t:
 

Since 2012, the Affordable Care Act has mandated that insurers cover the full costs of women’s contraception. But in practice, they simply don’t—especially for newer, more expensive forms of birth control. Most private health care plans are not fully covering about 50% of contraceptive products approved by the FDA after 2011, a damning October report from the U.S. House of Representatives found.

…“It’s pretty bad—and it’s just rampant,” says Mara Gandal-Powers, director of birth control access and senior counsel for the National Women’s Law Center. “Health insurance companies are not covering newer products the way they’re supposed to.”

This was an incredibly complicated project, and one where I’m really happy (if depressed!) with the results. It’s also one that I had a lot of fun writing, despite the enraging things I was covering. (Writer brag: My favorite line in the whole thing is the Pygmalion reference.)

A lot of that had to do with Evofem CEO Saundra Pelletier, whose profile opens and closes the story, and whose company has survived a lot of tragedy in the past decade. She’s a self-described “hustler” who might have hustled a little too hard, at least to promote a product that’s not as effective as existing (if also imperfect) types of birth control. But Evofem is also one of the only companies even trying to develop new types of contraception, given all the barriers to making a profit in this business ... and all of its competitors are crashing into the same systemic obstacles.

Pelletier’s passion, and the double-edged nature of how it shapes her business decisions, are part of what made her so fascinating to profile:
 

These [product] doubts could ultimately be the final blow to Evofem. They have, at least, given insurers another excuse to drag their feet on covering it. And if Phexxi turns out to be an also-ran contraceptive, insurance companies who blocked women from using it may have done an unintentional public service. But: emphasis on unintentional. “I think if the product was perfect, [insurers] would treat it exactly the same way,” says a senior executive at an Evofem competitor, which is also fighting health plans for better coverage.

Whatever happens to Evofem, it took two decades, hundreds of millions of dollars, and Pelletier’s fanatical commitment to get its product to market. There are very few companies willing to follow her lead—and if this generation of innovators fails, what happens to the next one?

Thank you for reading, commenting, and subscribing to this newsletter! Please tell your friends to sign up here, let me know what you think about this week's issue, and what else you'd like to see me write about: maria.aspan@gmail.com