The Biden-Harris Administration in the US has proposed new rules aimed at expanding coverage of preventive health services, including over-the-counter (OTC) contraceptives, under the Affordable Care Act (ACA).
This move by the Departments of Health and Human Services, Labor and the Treasury will help increase access to birth control and other critical health services without cost sharing.
Most group health plans and health insurance issuers would, for the first time, be mandated to cover OTC contraceptives without a prescription and without cost sharing.
This initiative by the Centers for Medicare & Medicaid Services (CMS) is designed to enhance consumer choices and ensure broader coverage of contraceptive drugs and products, such as a wider selection of oral contraceptive pills and intrauterine devices (IUDs).
The proposed regulations also aim to address the barriers to contraceptive coverage that many plans and issuers have imposed.
These barriers include step therapy protocols, burdensome administrative requirements and cost-sharing for services essential to the delivery of preventive care.
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By GlobalDataCMS Administrator Chiquita Brooks-LaSure said: “People with private coverage should know they have coverage of preventive services, including FDA [Food and Drug Administration]-approved contraception, at no additional cost – full stop.
“This historic action by the Biden-Harris Administration is vital to ensuring people have control over personal decisions about their health, lives and families – without facing financial barriers to accessing their birth control method of choice.”
The rules would also establish a transparent and expedient exceptions process for all recommended preventive services to cater to individuals facing limits on medically necessary care.
Since the ACA’s inception, it has been a requirement for most group health plans and health insurance issuers to cover preventive services recommended by various health authorities without cost sharing.
The new rules would reinforce these consumer protections, particularly in light of the Supreme Court’s decision to overturn Roe v. Wade, reflecting President Biden’s Executive Orders on Protecting Access to Reproductive Healthcare Services.
