HHS promoting access to contraceptive care

Photo: Luis Alvarez/Getty Images

The Department of Health and Human Services is renewing a push to protect and expand contraception access, sending a letter to Medicare plans, health insurance issuers and state Medicaid and CHIP programs about upholding their obligations under federal law.

HHS, along with the Departments of Labor and the Treasury, also issued new Frequently Asked Questions (FAQs) on how plans and issuers can ensure compliance with the requirement under the Affordable Care Act to cover contraception without cost-sharing. The updated FAQs outlined how plans and issuers can make sure they meet their contraception-coverage obligations.

Specifically, the departments announced a new pathway for plans and issuers to meet existing obligations under federal law by covering, at no cost, a broader range of FDA-approved contraceptive drugs and certain devices. 

The new guidance, said HHS, comes in response to reports that many plans and issuers continue to impose barriers to contraceptive coverage, such as requiring patients to satisfy step therapy protocols, imposing administrative requirements or requiring cost-sharing for services that are integral to the application of the preventive service provided.

WHAT'S THE IMPACT?

HHS also made updates to the Medicare Part D formulary clinical review process for plan year 2024 to include additional birth control types, such as intramuscular long-acting contraceptives and to include intrauterine devices (IUDs) for subsequent plan years.

The updates are designed to ensure that people with Medicare coverage have access to more covered types of birth control. The Centers for Medicare and Medicaid Services is also instructing local Medicare Administrative Contractors (MACs) to publish educational content making the public aware of the availability of IUD coverage for some conditions under Medicare Part B.

The departments also continue to consider the comments received in response to a recent Request for Information regarding the coverage of preventive products available over-the-counter without cost sharing, and without a prescription, to determine if and what additional actions they might take regarding the products.

THE LARGER TREND

Under the Affordable Care Act, most plans are required to offer coverage of birth control with no out-of-pocket cost. A new rule issued by the departments in January 2023 proposed to expand and strengthen access to this coverage so that all women who need or want birth control are able to obtain it. The Biden administration framed the action as the latest effort to bolster access to birth control at no cost.

The ACA and its implementing regulations guarantee coverage of women's preventive services, including birth control and contraceptive counseling, at no cost for women who are enrolled in group health plans or individual health insurance coverage.

The departments have taken a number of actions to expand birth control access. Previously, they convened a meeting with health insurers and called on the industry to commit to meeting their obligations to provide contraceptive coverage as required by the ACA.

The departments also issued guidance to clarify protections for birth control coverage under the ACA following multiple states' efforts to restrict access to contraception in the wake of the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization. HHS also announced nearly $3 million in new funding to bolster training and technical assistance for the nationwide network of Title X family planning providers.

HHS released a report in 2022 on actions taken to ensure access to reproductive healthcare, including contraception, following the Supreme Court's ruling, with further details on future actions and commitments.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.