House committee leaders wrote to Secretary of Health and Human Services
The letter to
“We are concerned that the health plans do not fully comply with the requirements of the law and accompanying regulations and guidelines, and we are seeking the help of departments to ensure that consumers have access to the range. complete with FDA-approved contraceptives at no cost. sharing, ”wrote the leaders of the Committee. “Recently, we have received reports of numerous denials of coverage and extensive medical management requirements that limit individuals’ access to the full line of FDA-approved contraceptives. These denials and medical management requirements appear to violate regulations. of the ACA. “
The ACA and its accompanying regulations and implementation guidelines require health plans and issuers to cover without cost sharing at least one form of contraception for each method approved by the FDA. This means that 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 such as determined by the FDA.
The leaders of the Committee continued: “Unfortunately, despite these regulations and guidelines, it appears that some health insurance plans and issuers, as well as their Pharmacy Benefit Managers (PBMs), are using medical management techniques beyond those applicable to health insurance. authorized by regulations and violate legal requirements that ensure that individuals can obtain cost-free coverage for the full range of FDA-approved contraceptives. “
The letter cites a series of examples of medical management techniques that limit access to contraceptive care, including: denying coverage by requiring individuals to try other contraceptive methods before allowing coverage for the desired method. ; requiring patients to try many other forms of the same contraceptive method, beyond what might be considered “reasonable”, before allowing coverage of the desired form; deny coverage for branded contraceptive methods for which there is no generic equivalent; and failing to provide an acceptable exceptions process.
“The ACA’s guarantee of coverage for the entire range of FDA-approved contraceptives without cost sharing has enabled individuals to choose the best method of birth control for themselves and has led women to increasingly use them. more effective contraceptive methods, or to use methods, such as oral contraceptives, in a more consistent manner, ”concluded the committee chairs. “In light of the serious concerns raised by these denials of coverage, we are asking the departments for assistance in ensuring appropriate consumer access to the full line of FDA-approved contraceptives, as required by law.”
To read the full letter, click HERE (https://edlabor.house.gov/download/house-chairs-letter-to-hhs-re-aca-contraceptive-mandate).