The University of Hawai'i is waiting to feel the effects of a two-year-old federal law that could eventually double the price of birth control pills for students using their clinics.

Like many universities across the country, UH locked in contracts with contraceptive manufacturers before the law went into effect in January 2005. Since then, the change in the formula for calculating Medicaid reimbursements has given drug companies less incentive to offer discounts to healthcare providers, since it would increase the reimbursement they would owe the state.

Now birth-control prices that have been increasing at UH could see steep hikes when the deals with pharmaceutical companies expire.

"If the contracts run out, the price is definitely going up," said Sue Myhre, the nurse coordinator for UH's Women's Health Clinic. "They've already been going up for the past year or two."

When Myhre first started working at the university years ago, the price for a month of pills was $2 to $3. "Just a few years ago, we charged $12 a cycle," she said. "Now our pills are $15 to $20 a package."

Some pills could end up costing $35 to $60 a month, and Myhre thinks that even a jump to $25 could cause hardship for students.

"Even now, they're asking if they can get a discount," she said.

Denise Matsuoka, a pharmacy student who works at the University of Hawai'i-Hilo health center, said it's very important to keep birth control costs low.

"We're studying and we don't work full-time jobs," she said. "Most of us work just to get by."

Students who use birth control are being responsible about preventing unwanted pregnancies, but if they're priced out of the market, Matsuoka suspects the result will be an increased birth rate.

She said the bottom line for some students will be: "Would you rather have birth control or food?"

Students who don't have birth control covered by private insurance can possibly have the cost of their pills subsidized by the state if they fall with federal poverty limits, so there is still some relief.

Christina Stidman, president of the Associated Students of the University of Hawai'i, said that she thinks any responsible person who is already using birth control will probably continue to use it, even if the price increases. However, if the price doubles, she worries that some students might not be able to afford it.

She believes that the health center should play an active part in students' lives. "If that means we need to find an alternative route for a student to still buy birth control at a low price ... we need to go down that avenue," she said.

The Medicare changes aren't the only factor driving up the cost of birth control.

Part of the problem is that many brand-name drug companies that once marketed to college students have gone out of business. Trade-name makers were more likely to give discounts to family-planning clinics in hopes of building brand loyalty. "Now a lot of the birth control pills are generic and those do not offer the same pricing," Myhre said.

So far, rising pill costs haven't led to any significant decline in students purchasing the birth control pill at UH-Manoa. Myhre said there has also been a decrease in pregnancy tests, as well as a decrease in the number of positive pregnancy tests.

That matches up with state statistics, which indicate teen pregnancies, including among college-aged teens, is dropping. In Hawai'i, the pregnancy rate among 18- and 19-year-olds has been on the decline since 2000, when it was 125 per 1,000 compared to 103 per 1,000 last year.

What Myhre has seen, though, is an increase in the number of students buying the "morning-after pill," an emergency contraceptive they can use within five days of unplanned or unprotected sex.

"When they use that, we try to get them in for a moment for the opportunity to talk to them about using a more reliable method," she said.

Reach Treena Shapiro at tshapiro@honoluluadvertiser.com.