Rep. Carolyn Maloney (D-N.Y.), as chair of the U.S. House of Representatives Oversight Committee, sent letters to the top insurance companies and their pharmacy benefit managers requesting information on their activities related to birth control coverage as required under the Affordable Care Act (ACA).
“I am deeply troubled by reports that health plans and issuers may not be fully complying with the ACA’s requirement to cover contraceptives at no cost, potentially depriving patients access to critically important reproductive healthcare,” Maloney said in letters to CVS Caremark, Express Scripts, OptumRx, and Prime Therapeutics, and health insurers UnitedHealth, Anthem, Aetna, Cigna and Humana.
“I am committed to uncovering the full extent of this problem and ensuring that every person can access the birth control that works best for them without unnecessary cost or delay,” she added. Maloney’s request for information comes after reports of companies denying and delaying contraceptives and related services contrary to the ACA coverage requirements.
Under the ACA, all non-grandfathered private health plans must cover the full range of contraceptives and related services without beneficiary cost sharing obligations. Although plans and issuers are allowed to use “reasonable medical management techniques” in administering benefits, each plan or issuer must cover at least one form of contraception for each Food and Drug Administration (FDA)-approved method, without patient cost-sharing.
I am deeply troubled by reports that health plans and issuers may not be fully complying with the ACA’s requirement to cover contraceptives at no cost, potentially depriving patients access to critically important reproductive healthcare.Rep. Carolyn Maloney (D-N.Y.)
The Maloney letters come at a time when a leaked draft decision written by Judge Samuel Alito, that if unchanged, would result in the Supreme Court overturning Roe v. Wade and resulting in the outlawing a woman’s right to abortions and endangering various forms of contraceptives. The right to privacy on reproductive healthcare was established under numerous decisions since 1965 with the Griswold v. Connecticut case on access to birth control as a right of privacy.
In 2015, the Centers for Medicare and Medicaid Services (CMS) issued guidance explaining that in order to meet the ACA requirements, plans and issuers must have a cost-sharing exceptions process in place for situations when a healthcare provider determines that a patient requires a specific contraceptive that is not typically covered without cost-sharing under that patient’s plan.
Public reporting and information obtained by the committee indicate that some plans and issuers, including their pharmacy benefit managers, have not been in compliance with the ACA’s no cost-sharing birth control coverage requirements. For example, reports indicate that plans and issuers are routinely not covering without cost-sharing contraceptive products that were recently approved by FDA, in particular contraceptive products approved by the FDA after 2011, as well as the services associated with contraception—such as office visits, counseling or the insertion or removal of a contraceptive device.
In addition, a recent investigative report found that when patients are denied coverage for a specific contraceptive product, plans and issuers do not always have in place an exceptions process that meets the requirements of CMS’s 2015 guidance.
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