House Committee leaders wrote to Health and Human Services Secretary
The letter to the
"We are concerned that health plans are not fully complying with the requirements under the law and accompanying regulations and guidance, and we seek the assistance of the Departments in ensuring that consumers have access to the full range of FDA-approved contraceptives without any cost-sharing," the Committee leaders wrote. "Recently, we received information regarding numerous denials of coverage and extensive medical management requirements that have limited individuals' access to the full range of FDA-approved contraceptives. These denials and medical management requirements appear to violate the ACA's regulations."
The ACA and its accompanying implementation regulations and guidelines require that health plans and issuers cover without cost-sharing at least one form of contraception for each FDA-approved method. This means health insurance plans and issuers must cover without cost-sharing at least one hormonal intrauterine device, oral contraceptive pill, implantable rod, vaginal ring, patch, and each of the other approved methods as determined by FDA.
The Committee leaders continued, "Unfortunately, despite these regulations and guidelines, it appears that certain health insurance plans and issuers, as well as their pharmacy benefit managers (PBMs), are using medical management techniques beyond those permitted in regulations and are in contravention of the requirements under the law that ensure individuals can obtain coverage without cost-sharing for the full range of FDA-approved contraceptives."
The letter cites a series of examples of medical management techniques that are limiting access to contraceptive care, including: denying coverage by requiring individuals to try other contraceptive methods prior to permitting coverage for the desired method; requiring patients try numerous other forms of the same contraception method, beyond what could be considered "reasonable," before permitting coverage of the desired form; denying coverage for brand name contraceptive methods for which no generic equivalent exists; and failing to provide an acceptable exceptions process.
"The ACA's guarantee of coverage for the full range of FDA-approved contraceptives without cost-sharing has allowed individuals to choose the best birth control method for themselves and has resulted in women increasingly utilizing more effective methods of contraceptives, or utilizing methods, such as oral contraceptives, in a more consistent manner," the Committee Chairs concluded. "Given the serious concerns raised by these denials of coverage, we ask for the Departments' assistance in ensuring appropriate consumer access to the full range of FDA-approved contraceptives as required by law."
To read the full letter, click HERE (https://energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/HHS.DOL_.Treasury%20Department.2021.10.6.%20Letter%20re%20ACA%20Contraceptive%20Mandate.pdf).