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A look at the federal mandate to cover contraceptives

A Kaiser Health News Q&A published yesterday takes a closer look at the much-discussed rule in the Affordable Care Act requiring insurance companies to provide contraceptives without a co-pay. The Q&A discusses who will be covered under the rule and whether the rule applies to male-based contraceptive methods or surgical procedures.

Regarding whether insurers are required to cover all products in a class, such as all intrauterine devices and all birth control pills, and whether insurers can require a co-pay for brand name drugs, writer Julie Appleby had this to say:

Many insurers have "tiered" pharmacy benefits under which patients pay differing amounts for brand-name, as opposed to generic, products. Some require patients who choose a brand-name drug, when an equivalent generic is available, to pay the price difference between the two. Insurers say HHS guidance allows them to use such "reasonable medical management" to help control costs. That would include allowing insurers to charge patients for brand name drugs, it says.

The HHS official confirmed that, but stressed the plan must "accommodate any individuals for whom it would be medically inappropriate by having a mechanism for waiving the otherwise applicable cost-sharing for the branded version."

Advocacy groups and insurers are in discussions with HHS over those and other questions related to preventive care, says [Judith Lichtman, senior advisor to the National Partnership for Women and Families]. Her group hopes the agency will soon release additional guidelines that “are broad enough so that all methods prescribed by doctors necessary for women’s health will be covered.”

Previously: Government advisors call for free contraception for women, Another birth control revolution? New health law could provide free contraceptives to women and Women’s health groups launch campaign for no-cost prescription birth control
Photo by Raychel Mendez

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