Democrats ask insurers to meet contraceptive coverage mandate
Source: Roll Call
Posted February 22, 2024 at 9:30am
The House Democratic Women’s Caucus has asked the biggest insurance association to urge insurers to comply with contraceptive coverage requirements and Biden administration guidance issued in January, according to a letter shared first with CQ Roll Call. The 2010 health care law requires most health plans to cover Food and Drug Administration-approved contraception without a copay for patients going to an in-network health provider. That extends to at least one type of birth control per category, such as emergency contraception or different forms of oral hormonal pills.
But since its inception, the mandate has faced pushback and been the subject of litigation over exceptions and enforcement of what is required. In January, the Biden administration issued guidance to health insurance companies outlining ways insurers could come into compliance with coverage regulations. The Health and Human Services Department allows insurers to use “reasonable medical management techniques” to determine how many products are covered per category.
Some patients have reported difficulty accessing certain newer approved forms of contraception or accessing alternative products that may have fewer side effects, according to the National Women’s Law Center, which administers the CoverHer hotline for navigating if an insurer may be incorrectly billing for contraception. The HHS guidance suggests that insurers use what is known as a therapeutic equivalence standard to ensure a drug with the same therapeutic benefit is still available for patients without cost-sharing or extra red tape. But it does not include a binding enforcement strategy.
The Democratic Women’s Caucus wrote to AHIP President and CEO Mike Tuffin on Thursday urging the group to have its members follow the suggestions HHS outlined. “Despite repeated clarification of these requirements from the Departments, multiple investigations — including by the House Oversight Committee — have revealed that plans routinely violate the [2010 health care law] by refusing to cover certain products, imposing administrative hurdles like prior authorizations and step therapy (fail first protocols), and requiring patient cost-sharing,” wrote the 143 House members as well as 13 senators.
Read more: https://rollcall.com/2024/02/22/democrats-ask-insurers-to-meet-contraceptive-coverage-mandate/
Link to Democratic Women's Caucus PRESS RELEASE - Dem Women’s Caucus Leads House and Senate Democrats in Demanding Health Insurers Fully Cover Birth Control, As Required by the ACA
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Congress generally codifies the amount (max) of fines in legislation so you can put 2 plus 2 together to get that 4 when it comes to the Executive Branch agencies trying to "enforce" the law. 
