Birth control access could increase after Biden administration proposal

Birth control access could increase after the Biden administration proposed new rules that would, for the first time, require most group health plans and health insurance issuers to cover over-the-counter contraceptives without cost sharing or requiring a prescription.

In addition, plans and issuers would have to provide consumers with more choices of covered contraceptives, such as a broader array of contraceptive drugs (for example, a wider selection of covered oral contraceptive pills) and drug-led combination products (for example, a wider selection of covered intrauterine devices).

Items that would be covered at no out-of-pocket charge include condoms, the “morning after” pill and birth control pills. Right now, health insurers must cover the cost of contraception prescribed by a health care professional, including birth control pills. The new rule would allow consumers with private health insurance to buy condoms, over-the-counter birth control pills and levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”

This action come a little more than year after a daily oral birth control pill, Opill, became the first over-the-counter birth control pill to be approved by the Food and Drug Administration. It became available for purchase online in March and can be purchased for $19.99.

Many plans continue to impose barriers

The proposed rules also further reinforce plans’ and issuers’ responsibility to cover birth control methods approved, cleared and granted by the Food and Drug Administration without cost sharing. This proposed rule comes in response to reports that many plans and issuers continue to impose barriers to contraceptive coverage, such as requiring patients to satisfy step therapy protocols, imposing unduly burdensome administrative requirements, or requiring cost-sharing for services that are integral to the application of the preventive service provided.

Since its inception, the Affordable Care Act has required most group health plans and health insurance issuers to provide coverage for preventive services recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the Health Resources and Services Administration, without any cost-sharing requirements, such as a copayment, coinsurance, or deductible. The proposed rules would strengthen these existing consumer protections by requiring plans and issuers to cover OTC contraception without a prescription and without cost sharing.

There will be a comment period on the proposed rule and if approved, it could go into effect in 2025. However, if former President Donald Trump wins the presidential election on Nov. 5, he could reverse the rule.

The proposed rule would not impact those on Medicaid. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods.