November 2024 Newsletter

Proposed Rule Requires Insurers to Cover Over-the-Counter Birth Control

Last week, the Biden administration proposed a rule that would require insurers to cover over-the-counter (OTC) birth control, including oral contraceptives, condoms, and emergency contraception, at no cost to patients with private insurance.

The rule from the Health and Human Services, Labor, and Treasury departments, proposed on October 21st, would expand access to contraception and aim to reduce out-of-pocket costs, affecting up to 52 million American women of reproductive age who rely on private health insurance, the White House said.

Building on the Affordable Care Act’s requirement that most private health plans must cover contraception without cost sharing, the proposed rule from the Departments of Health and Human Services (HHS), Labor, and the Treasury would:

·       Expand coverage of over-the-counter contraception without cost sharing. Under the proposed rule, for the first time, women would be able to obtain over-the-counter (OTC) contraception without a prescription at no additional cost. As a result, more women would be able to access and afford critical OTC medications such as emergency contraception and the first-ever daily oral contraceptive approved by the Food and Drug Administration (FDA) for use without a prescription that is now widely available across the country.

·       Make it easier to learn about coverage for OTC contraception. To help ensure that women understand this new benefit, most private health plans would be required to disclose that OTC contraception is covered without cost sharing and without a prescription—and take steps to help women learn more about their contraception coverage.

·       Strengthen coverage of prescribed contraception without cost sharing. The proposed rule would make it easier for most women with private health insurance to obtain contraception without cost sharing that is prescribed by their health care provider. Health plans would be required to cover every FDA-approved contraceptive drug or drug-led combination product without cost sharing unless the plan also covers a therapeutic equivalent without cost sharing, eliminating barriers that some women continue to face in accessing contraception prescribed by their provider.

Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control. But the new rule would expand that coverage, allowing people to get contraception, including “morning-after” pills, at a storefront for free without a prescription.

There will be a 60-day public comment period on the proposed rule. If approved, the rule could go into effect in 2025, according to senior administration officials. The rule would be the most significant expansion of contraception coverage under the Affordable Care Act since 2012, when contraception was first required to be covered.