Administration Proposes Rule to Expand Access to Contraceptives
- October 25, 2024
The Departments of Health and Human Services, Labor, and Treasury issued a proposed rule that would require most group health plans and health insurance issuers to cover over-the-counter (OTC) contraceptives without cost sharing or requiring a prescription.
According to a Centers for Medicare & Medicaid Services (CMS) fact sheet, the proposal “would better align coverage requirements with the statute and remove barriers, such as prescription requirements and out-of-pocket costs, that make it more difficult for women to access contraception.”
The agencies proposed an incremental approach to OTC coverage of recommended preventive services, and “have determined that focusing first on contraception is appropriate due to ongoing and widely reported concerns regarding challenges faced by consumers in accessing contraceptive items and services without cost sharing, as well as recent developments affecting access to reproductive health care.”
In July 2023, the Food and Drug Administration (FDA) approved Perrigo Company plc’s Opill (norgestrel) tablet as the first daily oral contraceptive for use without a prescription. Opill is now available at major retailers and pharmacies nationwide, as well as online, at a suggested manufacturer's price of $19.99 for a one-month supply.
Under the proposal, plans and issuers also would be required to provide consumers with more choices of covered contraceptives, including contraceptive drugs and drug-led combination products such as intrauterine devices.
“People with private coverage should know they have coverage of preventive services, including FDA-approved contraception, at no additional cost — full stop,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “This historic action by the Biden-Harris Administration is vital to ensuring people have control over personal decisions about their health, lives, and families — without facing financial barriers to accessing their birth control method of choice.”
The new rules build on guidance issued earlier this year aimed at shoring up access to contraceptives and family planning services.
The proposed rule also would require plans and issuers to add a disclosure to the results of any online Transparency in Coverage self-service tool search for covered contraceptives that explains OTC contraceptives are covered and include phone and web contacts for additional information regarding contraceptive coverage. The agencies noted the proposed rule would not modify federal conscience protections related to contraceptive coverage for employers, plans, and issuers.
The agencies also released additional guidance addressing plan and issuer coverage of other recommended preventive services—specifically, pre-exposure prophylaxis (PrEP), medication that reduces the risk of HIV infection—as required under the Affordable Care Act. The guidance reiterates the requirement to cover preventive PrEP and related services without cost sharing.
The guidance also responds to recent reports that plans and issuers are denying claims or imposing cost sharing for recommended preventive items and services because of how a provider codes for those services by clarifying how plans and issuers can mitigate challenges with coding and processing of claims for recommended preventive services to ensure that individuals are not improperly charged for important preventive care.