HHS Issues Reminder to Health Plans: Provide Contraceptive Coverage

Drug Topics JournalDrug Topics January/February 2024
Volume 168
Issue 01

The Affordable Care Act mandates that contraceptives must be covered by health plans and insurers without cost-sharing.

The Department of Health and Human Services (HHS) has issued new guidance1 to health plans and insurers to ensure they comply with the requirements to cover contraception without cost-sharing. HHS Secretary Xavier Becerra has sent a letter and updated Frequently Asked Questions (FAQs)2 to insurers, Medicare plans, and state Medicaid and CHIP programs about the new guidance.

Additionally, HHS also made updates to include intramuscular long-acting contraceptives and intrauterine devices (IUDs) to the Medicare Part D clinical formulary review process for 2024. “These updates will help ensure that people with Medicare coverage have access to more covered types of birth control,” HHS wrote in a press release.

These moves follow President Joe Biden’s executive order from June 2023 to ensure access to contraception.3 The 2023 executive order issued guidelines for health insurers, expanded walk-in services for active duty members and veterans, provided funding for training and expanding the telehealth infrastructure and inclusion of family planning providers in insurance networks for qualified health plans under the Affordable Care Act (ACA). Coverage of contraceptives and contraceptive care without cost-sharing is required under the ACA.

“In addition to this new guidance, and as we have previously made clear, we will continue to call on group health plan sponsors and issuers to remove impermissible barriers and ensure individuals in your plans have access to the contraceptive coverage they need, as required under the law. It is more important than ever to ensure access to contraceptive coverage without cost-sharing, as afforded by the ACA,” Becerra said in his letter.

The new guidance reminds group health plan sponsors and health insurance issuers of their obligations under the ACA to cover contraception at no additional cost. These services include FDA-approved, -cleared, or -granted contraceptives (including emergency contraception), effective family planning practices, and sterilization procedures to prevent unintended pregnancy.

HHS and the Departments of Labor and Treasury have also requested information about coverage of over-the-counter preventive products without a prescription. The departments may consider additional actions.

In July 2023, the FDA approved a nonprescription version of the contraceptive Opill (norgestrel).4 It is the first daily oral contraceptive approved for use in the United States without a prescription. Developed by HRA Pharma, a Perrigo company, the nonprescription Opill consists of 0.075 mg norgestrel and is a progestin-only daily birth control pill, which is also referred to as a mini pill or non-estrogen pill. The prescription Opill is not currently marketed.

President Biden said in last year’s guidance that it’s important to ensure access to contraception and family planning in light of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade. Since that decision, some states have restricted access to abortion and other essential health services. Millions of people continue to face barriers to obtaining the contraception they need even as access, the Biden administration said last year.

Misconceptions exist about emergency contraceptives and intrauterine devices, report last year from KFF found.5 They found that some states—such as Tennessee and Missouri, for example—that have limited access to abortion may also be limiting access to contraceptives. With restrictive definitions of pregnancy, they may potentially limit access to emergency contraceptives and intrauterine devices.

KFF found that 13 states—California, Colorado, Florida, Illinois, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington—as well as Washington, D.C., currently have legal or constitutional protections for the right to contraception.

This article originally appeared on Formulary Watch.

1. HHS Secretary Xavier Becerra announces new actions to increase contraceptive care coverage on 51st anniversary of Roe v. Wade. News release. Department of Health and Human Services. January 22, 2024. Accessed January 24, 2024. https://www.hhs.gov/about/news/2024/01/22/hhs-secretary-xavier-becerra-announces-new-actions-increase-contraceptive-care-coverage-51st-anniversary-roe-v-wade.html
2. FAQs About Affordable Care Act implementation part 64. Department of Health and Human Services. January 22, 2024. Accessed January 24, 2024. https://www.cms.gov/files/document/faqs-part-64.pdf
3. Fact Sheet: President Biden issues executive order on strengthening access to contraception. The White House. June 23, 2023. Accessed January 24, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2023/06/23/fact-sheet-president-biden-issues-executive-order-on-strengthening-access-to-contraception/
4. FDA approves first nonprescription daily oral contraceptive. News release. FDA. July 13, 2023. Accessed January 24, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive
5. Felix M, Sobel L, Salganicoff A. The right to contraception: state and federal actions, misinformation, and the courts. KFF. October 26, 2023. Accessed January 24, 2024. https://www.kff.org/womens-health-policy/issue-brief/the-right-to-contraception-state-and-federal-actions-misinformation-and-the-courts/
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