FOLLOWING INSURANCE GUIDANCE FROM PA. GOV. SHAPIRO ADMINISTRATION, CVS HEALTH PLANS JOINS GEISINGER HEALTH PLANS TO COVER OVER-THE-COUNTER BIRTH CONTROL AT NO COST

HARRISBURG, Pennsylvania, April 11 -- Gov. Josh Shapiro, D-Pennsylvania, issued the following news release on April 10, 2024:

Last week, with the launch of the first ever FDA approved over-the-counter (OTC) daily birth control pill, Opill, Governor Josh Shapiro urged health insurers in Pennsylvania to make contraception more accessible and affordable without unnecessary hurdles. Within a week, major insurers CVS Health Plans (https://thehill.com/policy/healthcare/4576837-cvs-drug-plans-will-cover-new-otc-birth-control-pill-for-free/) and Geisinger Health Plans announced that they will cover OTC contraception with or without a prescription at no cost - and Governor Shapiro is encouraging other insurers to follow their example.

"Last week, my Administration issued best practice guidance to health insurers to cover over the counter birth control with or without a prescription - and I called on insurance companies to step up. I am glad to see that CVS Health Plans are joining Geisinger Health Plans to cover Opill without a prescription -- and more insurers should follow suit," said Governor Josh Shapiro. "I've always fought to protect and defend access to reproductive healthcare, and my Administration will continue to hold insurers accountable and ensure that women have the personal freedom to make choices over their own bodies."

Pennsylvania insurers are strongly encouraged to cover OTC contraceptives with or without a prescription and are being asked to exempt this medication from the lengthy drug exceptions process as a best practice. If an insurer chooses not to cover OTC contraception options, the Pennsylvania Insurance Department (PID) will require them to provide additional information to verify compliance with federal law and regulations, assessing why OTC contraception is not covered by the health care plan and how policyholders can easily gain access to coverage.

"The Shapiro Administration is committed to supporting women's freedom to make their own healthcare decisions and the right to access the full scope of reproductive health care. PID is pushing companies to make sure exception processes are not preventing women from obtaining this healthcare," said Pennsylvania Insurance Commissioner Michael Humphreys. "We are glad to see insurers continue to take steps towards a best practice that ensures Pennsylvanians are empowered with choices in their reproductive healthcare."

Insurance coverage of OTC contraception may save women nearly $250 a year. The FDA recently approved the Opill (norgestrel) tablet for nonprescription use to prevent pregnancy, providing an option for Pennsylvanians to purchase this medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. This means that individuals will be able to access this contraceptive medication without the requirement to first see a healthcare provider. The medication currently costs around $20 for a one-month supply, with discounts for three- and six-month orders.

Opill has been classified as a progestin-only pill, which does not carry the same contraindications as some combination birth controls, so it may be a safer option for some individuals with certain medical conditions, such as high blood pressure, diabetes, and cardiovascular disease.

According to an article (https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive#:~:text=Today%2C%20the%20U.S.%20Food%20and,the%20U.S.%20without%20a%20prescription.) published by the FDA regarding the clinical research on Opill, when taken correctly, it is expected to be the most effective non-prescription contraception method available. Research has shown almost half of the over six million pregnancies annually in the U.S. are unintended, and unintended pregnancies have been linked to negative maternal and perinatal outcomes. Access to and availability of nonprescription Opill could help to reduce the number of unintended pregnancies in Pennsylvania.

Pennsylvanians who have any insurance related questions (https://www.insurance.pa.gov/Coverage/health-insurance/Pages/OTC-ContraceptionCoverage.aspx) or have an issue with their insurer or agent may file a complaint with PID by contacting PID's Consumer Services Bureau (https://www.insurance.pa.gov/Consumers/Pages/default.aspx), or by calling 1-877-881-6388.

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Original text here: https://www.governor.pa.gov/newsroom/following-insurance-guidance-from-shapiro-administration-cvs-health-plans-joins-geisinger-health-plans-to-cover-over-the-counter-birth-control-at-no-cost/