After nearly a year, still no word if Iowa AG will cover rape victim medication

Nearly a year after pausing payments as part of an audit of victim services administered through the Iowa Attorney General’s Office, state funding for emergency contraception for victims of sexual assault and rape remains in limbo.

While two counties have said they’d step in to help local victims if necessary, a Central Iowa sexual assault nurse examiner is working with a pharmaceutical company on an agreement to provide the medications to Iowa pharmacies at no cost.

Republican Iowa Attorney General Brenna Bird paused the funding as part of an audit of the victim services administered through her office. Bird announced the audit upon taking office last January.

Though the payments are not explicitly required by law, it has been the state’s longtime practice to cover the cost of emergency contraception from the victim compensation fund, which comes from fines, fees and penalties paid by criminals. No taxpayer dollars go into the fund. In rare cases, the fund also has paid for abortions for rape victims.

The Attorney General’s Office said in April it was reviewing the practice to evaluate “whether this is an appropriate use of public funds." The Attorney General’s Office did not respond to requests for comment and a list of questions submitted by The Gazette on the status of its review.

Victim advocates, including the Iowa Coalition Against Sexual Assault and Iowa Coalition Against Domestic Violence, have urged Bird to continue using the program’s funds to cover emergency contraception and abortion. They say cost should never be a barrier for rape victims seeking medical care, including contraception to prevent an unintended pregnancy or abortion.

Bird has not publicly said why she paused reimbursement for those services, and her office has not identified particular concerns. Speaking to The Gazette last month, Bird said her office was still putting together findings and “we’ll be announcing that soon.”

Asked what spurred the review and what her specific concerns were, Bird said: “When we release the review, we’ll go over all of that.”

“But, just as a prosecutor, I wanted to make sure that victims assistance is working well, and that we’re doing everything that we can do in all of the parts of the state,” she told The Gazette. “So that’s why we had those round table (discussions) all over Iowa to listen to victims advocates, prosecutors and law enforcement about how things are working in their areas. And we uncovered a number of problems and challenges and things that could be done to make things better. So that’s what we’re working on with the review and will be releasing that soon.”

Bird declined to elaborate as to what issues arose as part of those discussions.

“We’ll put it all out there with what we found at the different round tables and some of the comments, and also how we’re going to be working through some things that we can make victims’ assistance better in Iowa,” she said. “That’s why the review has taken a little while.”

As of this summer, more than 160 reimbursement requests for emergency contraception provided to sexual assault survivors from across the state were pending approval from the Iowa Attorney General’s Office. According to records obtained by The Gazette, and first reported by Iowa Public Radio, the reimbursement requests from hospitals and pharmacies across the state totaled about $7,000. The vast majority are from this year, but one dates to August 2020. One is coded as confirmed child abuse.

The Attorney General’s Office has not disclosed how much it previously spent on emergency contraceptives and abortions. It also has not provided an update on the number of requests for reimbursement that have been submitted by providers since the pause in payments went into effect.

Counties hold off on funding

The Polk and Johnson County boards of supervisors earlier this year authorized funding for emergency contraception and support services for victims of sexual assault and rape as the state program remains in question.

Neither county has yet paid for any emergency contraception as pharmacies are either continuing to submit invoices to the Attorney General’s Office or holding onto them until a final decision is made, according to county officials.

The pharmacies that victims most commonly access for emergency contraception have been informed that Polk County will pay invoices should the Attorney General’s Office ultimately decide to not cover them, said Eric Kool, director of Polk County Community, Family and Youth Services, which oversees the county's sexual assault response team.

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Year to date, the team has responded to 255 reported sexual assaults in Polk County. Ninety-nine of those victims requested and received emergency contraception.

Since Aug. 8, when the Polk County Board of Supervisor passed a resolution to provide funding for emergency contraception if the Attorney General’s Office makes a final decision to not reimburse pharmacies, the team has responded to 77 sexual assaults. Thirty-one victims requested and received emergency contraception.

“We continue to believe it is best for the AG’s office to continue the long-standing precedent of providing funds for emergency contraception, and we are hopeful that decision will be reached sooner than later,” Kool said. “Continuing this service would provide the most consistency and equity statewide, including for locations where local funding has not yet been committed to doing so. It is also consistent with the long-standing good work of the AG’s office to support sexual assault victims.

“It is not paid for from taxpayer funds, and the goal with emergency contraception is to prevent pregnancy arising from violent sexual assaults, which appears to be widely common ground.”

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Drug company may donate medication

Bird has been a vocal opponent of abortion, and said the pause has been for “reimbursement, for example, to Planned Parenthood for an abortion or for abortion pills, things of that nature.”

Sexual assault nurse examiners, along with other victim advocates, have emphasized that emergency contraceptives are not abortion pills. The medication delays or prevents ovulation, preventing a pregnancy from occurring, according to the U.S. Food and Drug Administration.

“It has no effect on an existing pregnancy and will not affect implantation,” said Katy Rasmussen, coordinator for the Johnson County Sexual Assault Response Team. “It’s a completely different drug than abortion medication, and we do not offer abortion medication to our patients.”

So far this year, she said the county's sexual assault response team responded to at least 80 patients between the ages of 13 and 60 who would have been offered emergency contraception if they met the guidelines.

"It’s been nine months of waiting for a clear answer on this … and it’s really hard to plan for the program and the future and best serve our patients when we’re left in limbo,“ Rasmussen said. ”I have no knowledge of how this process works or what the audit entails, but I never expected it would take this long.“

Shannon Knudsen is the coordinator for sexual assault nurse examiners for Polk and Story counties.

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Knudsen said she is working with a pharmaceutical company, which she would not name, to develop a statewide voucher program where the company would directly donate medications, including emergency contraception and prescriptions to treat sexually transmitted diseases, to pharmacies who dispense them to victims of sexual assault.

“We just want to take care of our community and our patients,” Knudsen said. “I’m hopeful to have a more concrete plan in place for the first part of the year for assistance with pharmaceutical companies.”

Comments: (319) 398-8499; tom.barton@thegazette.com