Hassan, colleagues press for answers from top companies illegally delaying or denying patients insurance coverage for birth control

WASHINGTON – U.S. Sen. Maggie Hassan and colleagues are pressing for answers from CVS Caremark, Optum Rx, and Express Scripts–the nation's largest pharmacy benefits managers (PBMs), which make key coverage decisions about 80% of the prescriptions filled in the U.S. — amid ongoing reports that they are illegally delaying or denying patients insurance coverage for birth control.

"We have heard numerous accounts of PBMs requiring prior authorization, denying claims, or asking patients to try multiple forms of contraceptives before approving them for the product recommended by their health care provider. These opaque and burdensome practices run counter to the goals of the ACA–ensuring access to prescription birth control that is free at the point-of-sale," wrote the Senators.

The Affordable Care Act requires that companies fully cover patients' birth control with no out-of-pocket costs or extra steps. Despite these protections, top companies continue to force patients to jump through harmful, unnecessary hoops or pay out-of-pocket to get the birth control that they need to stay healthy. In their letters to CVS Caremark, Optum Rx, and Express Scripts, the Senators called on the PBMs to fully cover patients' birth control and clearly detail their policies related to contraception coverage.

"Patients should not have to jump through burdensome hoops or pay extra just to get the birth control they need to stay healthy and plan a family on their own terms. We therefore ask you ensure your policies are compliant with the law and provide the requested information so we may better understand the scope, evolution, and impact of your policies," wrote the Senators.

Recent reports have made clear that despite the ACA's clear contraception coverage requirement, some insurers and the PBMs they hire to manage drug benefits on their behalf are forcing patients to pay extra for birth control or jump through unnecessary and harmful hoops to get their chosen birth control method covered. In some cases, patients have been asked to demonstrate that they have failed with as many as five different birth control options before they can get their birth control covered.

In February, Hassan led 33 Senators in calling on the Biden administration to improve enforcement of the federal law that guarantees complete coverage of birth control for women who get their health insurance through the ACA or their employer.