Women Leaders Rally and Urge Health Insurers to Comply with ACA Birth Control Coverage

A coalition of women, including members of the Democratic Women’s Caucus (DWC), Pro-Choice Caucus Contraception & Family Planning Task Force, and Senators, took the lead in rallying over 150 House and Senate Democratic colleagues, urging health insurers to fully comply with the recent birth control coverage requirement outlined in the Affordable Care Act (ACA).

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This follows after the large group of lawmakers wrote a letter yesterday to America’s Health Insurance Plans (AHIP) President and CEO Mike Tuffin addressing that AHIP’s “members are not complying with the Affordable Care Act contraception coverage requirement, and to urge them to consider immediate adoption of the therapeutic equivalence standard outlined by the Departments of Health and Human Services, Labor, and Treasury [the Departments] on January 22, 2024.”

Traditionally, under the ACA, most plans are required to offer coverage of birth control with no out-of-pocket cost. To date, millions of women have benefited from this coverage, according to the Center for Medicare & Medicaid Services (CMS).

The new rule by The U.S. Department of Health & Human Services (HHS), along with the Departments, mandates coverage under the ACA without cost-sharing for all FDA-approved contraceptive products lacking therapeutic equivalents, aligning with the Biden-Harris Administration's commitment to free access.

The letter also states, “Despite repeated clarification of these requirements from the Departments, multiple investigations—including by the House Oversight Committee—have revealed that plans routinely violate the ACA by refusing to cover certain products, imposing administrative hurdles like prior authorizations and step therapy (fail first protocols), and requiring patient cost-sharing.”

In response to claimed compliance issue, an AHIP spokesperson shared with Managed Healthcare Executive, “Ensuring robust and affordable coverage of contraception as required under law remains a priority for health insurance plans. We appreciate the interest from members of Congress and look forward to sharing more information on implementation of this latest guidance.”

After the January rule was proposed, HHS Secretary Xavier Becerra said in a CMS report that “Now more than ever, access to and coverage of birth control is critical as the Biden-Harris Administration works to help ensure women everywhere can get the contraception they need, when they need it, and – thanks to the ACA – with no out-of-pocket cost.”

The rule “works to ensure that the tens of millions of women across the country who have and will benefit from the ACA will be protected. It says to women across the country, we have your back,” he added.

Some may be able to recall that more than half of the 37 million U.S. women needing contraceptive services in 2010 sought publicly funded services, with 1 in 4 obtaining them at publicly funded family planning clinics, according to a report by The American College of Obstetricians and Gynecologists.

The number of women requiring publicly funded contraceptive services increased by 17% (nearly 3 million) from 2000 to 2010.

In 2010, publicly funded contraceptive services provided at centers led to an estimated $7.6 billion in cost savings for federal and state governments.

While there are still obvious challenges among affording birth control, efforts to improve accessing the contraceptive without a prescription were made back in July 2023 when the FDA approved the first-ever over-the-counter birth control pill in the United States.

Opill, (norgestrel) is a progestin-only pill that was originally approved by the FDA in 1973 for prescription use. Opill is full prescription-strength and is 98% effective, when used as directed. have been considered a safe method of contraception for nearly 50 years.

When approved, Opill was expected to be on the shelves in common retail stores and sold online by January 2024, but according to the birth control’s website it’s still “coming soon.”

A price for Opill is not yet listed.