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Assuming a patient copayment of 20%, that would mean at least $18,000 in out-of-pocket spending.

An additional three states and the District of Columbia require coverage of over-the-counter contraception without a prescription but don’t specify whether a copayment may be required.

For example, it would make it more difficult to afford your copayment to see your primary care doctor or your medications.

Millions of people get screened for breast, colorectal, lung, or cervical cancer each year, she said, adding there is evidence showing any kind of copayment or deductible deters people from getting such testing.

Even if an employer were to add a 20% copayment for the worker, it would reduce overall spending by less than one-tenth of 1%, according to the study.