CPAT

Stay Informed

House Investigation Finds Birth Control Coverage Gaps Led By Insurers and Middlemen

House Investigation Finds Birth Control Coverage Gaps Led By Insurers and Middlemen

The Supreme Court overturning Roe v. Wade created a ripple effect for reproductive health rights and access to care. Recently, an outdated FDA birth control method chart has been used as a weapon against consumers, dictating which products will or won’t be accessible at no cost. An investigation by the House Committee on Oversight and Reform found that healthcare plans and Pharmacy Benefit Managers (PBMs) are not abiding by the requirements put forth by the Affordable Care Act (ACA) to cover FDA-approved contraceptives. The ACA requires insurance companies to completely cover the cost of birth control subscriptions based on a doctor’s recommendation, regardless of the products being name brand or generic. Yet, insurance companies misinterpreted the FDA chart as an alibi to push generic medications onto patients, rather than the products that work for each consumer.

The FDA’s birth control chart is intended to be used solely for educational purposes stating, “this birth control chart provides high-level information about different birth control options and is not meant to be a complete list of all available birth control options. Talk to your healthcare provider about the best birth control choice for you.” The House Committee investigation into these insurers and PBMs found that more than 30 birth control products had cost-sharing requirements or coverage restrictions, and 12 of those products had no equivalent product available to consumers, a clear violation of the ACA.

In addition, the Biden Administration is actively working to instate reproductive health policies that can be used as aid in the overturning of Roe v. Wade. The departments of Health and Human Services, Labor, and Treasury have also acted for the rights of patients’ drug choices by implementing a pressure campaign, which safeguards access to free contraception, as required under the law. By limiting access to birth control methods put forth by a patient’s doctor, insurance companies and their PBMs are exacerbating existing coverage gaps that often disproportionately affect underserved patients.

Birth control categories, processes of insurance distribution, and cost were established more than a decade ago. A reassessment for clarification is crucial for patients to receive the methods of birth control they desire, especially in the wake of Roe v. Wade’s reversal. Since this significant change for health in America, access to birth control at affordable rates is a critical necessity for many Americans.