The letter thus calls on the tri-agencies to adopt the recommendations of the October report by requiring health plans to cover “every contraceptive product that has been approved, granted, or cleared by the [FDA], unless there is a covered therapeutic equivalent,” reflecting recent guidelines from the Health Resources and Services Administration, or HRSA. A birth control pill, for example, may have several generic equivalents, but other contraceptive products do not; the Democratic Women’s Caucus is arguing that those products without equivalents should be also included on plan formularies—that is, insurers’ lists of covered medications.
The second request in the letter pertains to over-the-counter contraceptives. Some health insurance plans require prescriptions to provide coverage, even for products typically sold over the counter, including emergency contraceptives such as Plan B and condoms. This is based on the original guidelines for insurers from HRSA from 2011, which covered contraceptive products and services “as prescribed.” Subsequent guidance from HRSA dropped that language, and the most recent guidance recommends that “the full range of [FDA]-approved, -granted, or -cleared contraceptives, effective family planning practices, and sterilization procedures be available as part of contraceptive care.”
Ironically, making a product more accessible over the counter can make it less accessible in terms of cost. For example, Plan B was approved as an over-the-counter medication in 2013, but insurers could then argue that it no longer falls under the ACA prescription requirement and is as such subject to cost-sharing. The letter’s signatories have called on the Biden administration to clear this roadblock.