Proposed rule to expand coverage of OTC contraception

The Pennsylvania Insurance Department (PID) today announced its support for the Biden-Harris Administration's proposed rule that would require most health insurers to cover over-the-counter (OTC) contraceptives without cost-sharing or a prescription.

This new federal proposal comes after Governor Josh Shapiro, in conjunction with governors from five other states, urged the Biden-Harris Administration to ensure that the first-ever FDA approved OTC daily birth control pill, Opill, would be covered without cost-sharing.

"This proposed regulation is a great step towards expanding women's access to safe and affordable contraception," said Pennsylvania Insurance Commissioner Michael Humphreys. "Insurers are already required to cover prescription contraception under most plans; it only makes sense that they be required to cover FDA-approved OTC contraception. Pennsylvania's health plans recognized the importance of covering OTC contraception for women, and we're proud to say that in response to Governor Shapiro's call for greater OTC coverage earlier this year, all of our individual and small group plans will offer this benefit in 2025 — a few already provide it. The Shapiro Administration will always support a woman's freedom to make her own healthcare decisions and her right to access the full scope of contraceptive healthcare."

Earlier this year, Governor Shapiro further urged health insurers in Pennsylvania to make contraception more accessible and affordable. At that time, PID announced best practice guidance on insurance coverage for OTC contraception and strongly encouraged insurers to cover OTC contraceptives.

Starting in 2025, Pennsylvanians will see full coverage of Opill with no cost-sharing by all individual and small group market insurers, which include all health insurance plans offered on Pennie. Pennsylvanians will also see many of those individual and small group market insurers cover a broader range of contraceptive drugs, including contraceptive drugs that have no therapeutic equivalents.

The proposed federal rule would apply to plan years beginning on or after January 1, 2026. The rule would require plans and issuers to cover OTC contraceptives and certain other preventive health care items without cost-sharing and also would mandate related disclosures in the Transparency in Coverage search tool.

Pennsylvanians can visit PID's website for more information on insurance coverage for OTC contraception.

Additionally, Pennsylvanians who have any insurance related questions or have an issue with their insurer or agent may file a complaint with PID by contacting PID's Consumer Services Bureau, or by calling 1-877-881-6388.

Follow PID on X and like the Department on Facebook.