Despite Health Law Rules, Some Contraceptives May Require Co-Payments
It鈥檚 been more than two years since most health plans have been required to cover all Food and Drug Administration-approved methods of contraception without requiring women to pay anything out-of-pocket. But even though an unplanned pregnancy would cost an insurer a lot more than the contraceptives to prevent it, some insurers still try to limit what they cover.
In a recent twist, a reader wrote to Kaiser Health News saying that her daughter鈥檚 insurer had moved her generic birth control pill聽out of the zero copayment tier of her plan鈥檚 formulary into a higher tier that requires cost sharing of $19 per month.
That鈥檚 not surprising, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. Regulations that allow insurers to use 鈥渞easonable medical management techniques鈥 to control costs open the door to excluding some generic pills from free coverage, Sonfield says.
The a plan to charge for a brand-name contraceptive, for example, if an equivalent generic is available without charge.
But it doesn鈥檛 follow that a plan can charge for most generics as long as it offers some for free, Sonfield says.
鈥淎ll generics aren鈥檛 the same,鈥 he says. 鈥淎ll of the different formulations should be on the zero tier, but that isn鈥檛 clear in the current guidelines.鈥
The health law鈥檚 are aimed at improving preventive care for women.聽Most health plans have to comply. Plans with grandfathered status under the law are exempt as are those covering employees of religious institutions and certain privately held companies whose owners have a religious objection to covering contraception for their employees.
This isn鈥檛 the only instance in which insurers have tried to sidestep the law鈥檚 contraceptive coverage requirements. Some insurers have , claiming that those methods use the same hormones as birth control pills. Administration officials said they were separate types of hormonal methods and grouping them together isn鈥檛 permitted.
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