Following Roe ruling, Biden administration warns payers… Leave a comment

Dive Brief:

  • On the heels of a bombshell Supreme Court ruling overturning Roe v. Wade, restricting access to abortion in dozens of states, the Biden administration is mounting a full-court press to remind insurers they are legally required to cover contraception at no cost.
  • The Affordable Care Act guarantees coverage of women’s preventive health services, including free birth control and contraceptive counseling, for individuals and covered dependents in all 50 states, HHS Secretary Xavier Becerra, Labor Secretary Marty Walsh and Treasury Secretary Janet Yellen wrote in a letter to group health plans and health insurance issuers on Monday. Becerra and Walsh also met with a number of payers and health insurance groups to stress the importance of contraceptive coverage.
  • Historically, compliance with this provision of the law has been inconsistent, but the stakes for women’s health are significantly higher given the Supreme Court’s decision on Friday. Demand for contraception has surged following the ruling. 

Dive Insight:

The Biden administration is reminding payers about their obligation to cover contraception in all U.S. states after the Supreme Court’s ruling on Friday overturned decades of legal precedent, throwing patients and providers into a state-by-state legal quagmire over reproductive medical care. 

“We are calling on your organizations to remove impermissible barriers and ensure individuals in your plans have access to the contraceptive coverage they need, as required under the law. It is more important than ever to ensure access to contraceptive coverage without cost sharing, as afforded by the ACA,” the letter to payers reads.

Plans must cover at least one form of contraception in each of the contraceptive categories defined by the Food and Drug Administration, including instances where a contraceptive product recommended by a patient’s provider doesn’t fall within an identified category, without cost sharing.

The mandate doesn’t apply to uninsured individuals or patients covered by church plans, religious nonprofits or employers that object to contraception. It also leaves out a significant number of birth control products.

Even covered products can be subject to requirements like prior authorization or cost sharing, if patients aren’t outright denied for their preferred method of contraception, according to nonprofit reports.

Democrats in the House and Senate have called on regulators to issue guidance and take enforcement action against plans that are noncompliant with birth control coverage requirements.

“We continue to be concerned about these complaints and may take enforcement or other corrective actions as appropriate,” the secretaries wrote to payers.

Becerra and Walsh on Monday also met with a number of payers and health insurance groups, including CVS, UnitedHealth, Humana, Centene, the Blue Cross Blue Shield Association and industry lobby AHIP, to stress the importance of covering contraception.

CVS, Walmart and Rite Aid have been rationing over-the-counter emergency contraceptive pills, many of which are in short supply or sold out amid rising demand following the Supreme Court’s ruling. Meanwhile, a telemedicine company that provides contraceptives reported its volume was up more than 5,000% just three days after the ruling.

Some legal experts have warned the Supreme Court’s reasoning in the highly controversial decision also throws into concern other rulings related to Roe, including those protecting same-sex marriage and access to contraception. Democrat lawmakers have warned that the conservative court majority might set their sights on birth control next.

Though Trump-appointed Justice Brett Kavanaugh wrote in his concurring opinion that overruling Roe doesn’t overrule the precedents involving the right to contraception, conservative Justice Clarence Thomas in his opinion argued the court “should reconsider” those rulings.


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