In a FAQ issued on May 11, the Administration made clear that all 18 methods of contraception included in the Food and Drug Administration’s (FDA) Birth Control Guide must be covered without cost under the Affordable Care Act (ACA). Aimed squarely at insurers and group health plans that were denying coverage for some methods, the document was issued jointly by the Departments of Health and Human Services, Labor, and Treasury.
In its blog about the FAQ, Health Affairs cited reports from the Kaiser Family Foundation and the National Women’s Law Center, which found gaps in contraceptive coverage under the ACA. In at least 5 and as many as 15 states, numerous plans were not covering all forms of birth control and had no process for waivers for provision of contraceptives to patients with a medical need but who were not otherwise eligible to receive them.
Forms of birth control identified by the FDA and referenced in the FAQ include sterilization, implantable rods, intrauterine devices, oral contraceptives, patches, rings, the diaphragm, the sponge, cervical cap, female condom, spermicide, and emergency contraception. The document also makes clear that coverage “must also include the clinical services, including patient education and counseling, needed for provision of the contraceptive method.”
Plans and insurers can impose cost sharing for contraception to encourage use of certain methods and they must have an “easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider.” If a provider recommends a particular type of birth control because of medical necessity, the plan or issue must cover that method without cost sharing. Coverage of some forms of contraception without cost sharing while excluding other forms entirely from coverage is not in compliance with the terms of ACA.
In its statement regarding the FAQ, the American College of Obstetricians and Gynecologists said the organization hopes the clarification “will help ensure that all FDA-approved methods of birth control are covered by insurance companies, as mandated by the Affordable Care Act, so that every woman is able to get the contraceptive that is right for her.” The Association of Reproductive Health Professionals called the guidance “an essential next step toward securing the right to quality reproductive health care for all.”