Gov. Brian Sandoval (R) signed bipartisan legislation last week to make Nevada the fifth state to protect birth control access by enshrining into state law the Affordable Care Act’s (ACA) no-copay requirement on contraceptives.

SB 233 also expands contraceptive access by requiring pharmacists to dispense up to a year’s supply of birth control at a time. 

More than 55 million cisgender women and an untold number of transgender folks have birth control coverage without out-of-pocket costs because of the ACA, or Obamacare. The federal law requires health insurance to cover 18 contraceptive methods without charging a co-pay.

With Obamacare under attack by the Trump administration and congressional Republicans, state legislators are emerging as front-line defenders of birth control access.

“This new law shows that Nevada can lead the resistance protecting women and our families,” Caroline Mello Roberson, state director with NARAL Pro-Choice Nevada, said in a statement. “No woman should have to deal with an unplanned pregnancy because she couldn’t get to the pharmacy on time or because a politician took away her birth control.”

SB 233 applies to private health insurance plans and certain state health insurance programs.

Three states—California, Illinois, and Vermont—prohibit birth control “cost sharing,” according to the Guttmacher Institute. A Maryland ban on contraceptive cost-sharing is set to go into effect next year.

The Nevada legislation gained bipartisan support, buoyed by intense lobbying and statewide outreach through a series of “Feminist Road Trips” by NARAL Pro-Choice Nevada, according to state reproductive rights advocates. Democrats hold a majority in the state Assembly, along with a two-seat edge over Republicans in the state senate. The bill gained Republican votes in both chambers.

Insurers typically cover a one- to three-month supply of birth control. Four states and the District of Columbia require insurers to cover an extended supply of birth control, in some cases up to a year’s worth, according to the Guttmacher Institute. In Ohio, pharmacists may dispense a year’s worth of contraceptives, but health plans are not required to cover the full cost of the contraceptives all at once.

Research suggests giving a year’s supply of birth control all at once reduces the number of unintended pregnancies. Women who received a year’s supply of birth control were about a third less likely to have an unplanned pregnancy, compared to those with a one- or three-month supply, according to a 2011 study of 84,401 California women in Obstetrics and Gynecology. They were 46 percent less likely to have an abortion.