Insurance coverage of oral contraceptives
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Birth control often not covered by Canadian insurers
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The Importance and Feasibility of Prescription Contraceptive Coverage Access to contraception is important to the health and well-being of women and families. If women cannot afford effective prescription contraceptives, they are likely to use less effective or appropriate methods or to not use any contraception at all, both of which increase the risk of unintended pregnancy. It is also economically feasible to do so.
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One of the most commonly asserted arguments against mandating insurance coverage for contraceptives is that given Insurancd number of women who use prescription contraceptives and the length of time for which they use them, the cost would be prohibitive, particularly for small businesses. As described above, each of the prescription contraceptive methods requires an examination by a physician before the prescription is given. Many women who cannot afford prescription contraceptives similarly cannot afford these examinations, and Insurace lose the opportunities for the early detection of many different contraceptivse that such examinations provide.
Although there are clearly costs conyraceptives with contracdptives coverage of conttaceptives contraceptives, the contracfptives are substantial and extend ooral the women who receive the prescription coverage. All contarceptives society bears the costs of unintended pregnancies, and as a cost-effective method of reducing these costs, mandating coverage of contraceptives must be seriously considered. The Regulation of Insurance in ogal United States Insurance plans are subject to different sources of regulation depending on the specific type of plan.
As a result, no single mandate will guarantee that every insured contracephives will have access to prescription contraceptive coverage. Such plans may be fully self-insured, whereby employers contract with conventional insurers or administrators to process claims, or may be contracrptives self-insured, whereby employers contract with conventional insurers both to contracwptives claims and to insure against very large claims. Congress took this approach in ERISA in part because even though insurance is considered part of interstate commerce, Congress has traditionally deferred regulation of insurance to the states.
Indeed, self-insuring is one of the major trends in private health insurance precisely because it allows employers to avoid state regulation. ERISA explicitly provides that it does not preempt federal law,  and hence other federal antidiscrimination provisions may be used to require employers with self-funded plans to provide coverage. The Erickson case and other opportunities for the judiciary to take action in the face of Congressional hesitation are discussed later in this paper. The nature of our insurance regulation system makes the campaign for equality in insurance coverage necessarily a multi-faceted one.
But as the following Parts will show, each of the different governmental players has shown a willingness to consider the issue. As the momentum behind the movement continues to build, it is likely that the favorable actions taken by the more willing government branches will encourage those that are more hesitant to follow. InMaryland was the first state to enact a law mandating contraceptive coverage. Since that time, many states have followed with laws or regulations addressing contraceptive coverage for state employees and in the private insurance market. Each state has taken a different combination of steps toward coverage, but the movement has been decidedly in the direction of greater coverage, with increasing numbers of bills introduced and statutes passed each year.
This Part will summarize the different approaches taken in the states, identifying which are the most beneficial and effective and which provide much more limited coverage. It will consider both statutes and regulations relating first to public employees and then to private insurance. It will conclude with a discussion of conscience clauses, which are frequently inserted in state statutes and provide an exception for religious insurers and employers who are opposed to contraception. Contraceptive Coverage for Public Employees Generally speaking, public employee health plans are more likely to cover prescription contraceptives than private insurance plans.
On the state level, thirty-nine states require some level of coverage. But this number is still encouraging, especially given that only ten states mandated any type of coverage for state employees in Thirteen states provide the most secure and comprehensive coverage for state employees, in the form of a statute mandating that all state employee health plans that provide prescription coverage also cover each of the FDA-approved prescription contraceptives. Twenty states require at least some coverage for contraception in at least some of the state employee insurance plans.
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California is the only state that requires partial coverage coverae prescription contraceptives by statute. Coverage of oral contraceptives only is now required in Alabama not as Insurancw result of a state statute, but after a state Employee Insurance Board decision. These policies also vary greatly in the comprehensiveness of the coverage they require. For example, the Arkansas Insurance coverage of oral contraceptives and Ora School Employees Life and Health Insurance Board policy requires coverage of oral contraceptives only,  while the state policy in Massachusetts requires coverage of all contraceptive drugs and devices. The rest of the states do not have any contraceptive coverage mandate, whether by statute, Board decision, or policy.
In these states prescription contraceptives are generally at least partially covered by state benefit plans, however. Arizona does not have a statute or official policy contracephives coverage, but does have state guidelines for prospective health plans that recommend coverage. Also, some states have employee health plans that cvoerage contraceptive coverage even though no state law, policy, or guidelines mandate coverage. Two of these state insurance plans voluntarily provide comprehensive coverage of all FDA-approved contraceptives, but most provide only Inssurance coverage. Although much progress ora, been made in this area, there are still some states that have not only failed to mandate or recommend that state employee health plans include contraceptive coverage, but that also do not have any state health plans that voluntarily cover contraceptives.
Montana and North Dakota have no such requirements, and their state health plans currently provide coverage for oral contraceptives only if prescribed for medically necessary, non-contraceptive purposes. Activists should target these states using the models of other states as an example of the feasibility of mandating this coverage. Contraceptive Coverage Mandates for Private Insurance Sincefifteen states have passed statutes that require all insurers that cover prescription drugs and devices to cover prescription contraceptives as well. Intwenty-two states considered a total of fifty-five bills to provide private insurance coverage for contraceptives, and intwenty-five states and the District of Columbia also considered fifty-five total bills.
NARAL predicts that in ten more states will seriously consider such legislation, with New York, Pennsylvania, and Wisconsin deemed likely to enact legislation. It does not extend to employers who maintain their own benefit plans. Mandates applicable to all state insurers. Activists pressing for legislation in other states should be conscious of the subtle differences between the current statutes and the implications of those differences, and should push for the most comprehensive coverage in their lobbying efforts. The broadest statutes require coverage of all FDA-approved prescription contraceptive drugs and devices, as well as coverage of all related contraceptive services, so long as the insurer otherwise covers prescription drugs, devices, and outpatient services.
These services generally include the appointment necessary to prescribe the contraceptive, and if necessary to insert the contraceptive as well. Additionally, these statutes explicitly forbid a number of actions by insurers, such as imposing different deductibles, copayments, or waiting periods than are imposed on other prescription drugs, denying eligibility for plan coverage because of current or potential future use of contraceptives, offering women financial benefits to take less comprehensive contraceptive coverage, penalizing a health care professional for prescribing contraceptives, or providing incentives to encourage health care professionals not to prescribe contraceptives.
As such, they are the ideal template to aid in constructing future state statutes. The next level of comprehensiveness is illustrated by the Hawaii statute. It requires coverage of all FDA-approved prescription contraceptive drugs and devices and all contraceptive services, provided that the insurer normally provides such coverage outside of the contraceptive context. More than half of women in the United States are insured through an employer-sponsored plan, either as the primary beneficiary or as a spouse or dependent. Only a small share of women has historically purchased insurance directly from an insurance company on the individual market, but this share is growing as previously uninsured women can now purchase coverage through ACA Marketplaces.
While most health plans are now required to provide contraceptive methods and counseling to women with reproductive capacity with no out-of-pocket costs, there are certain conditions that must be met. Women must be enrolled in a non-grandfathered plan 17 and they must get services from an in-network provider.
In response to reports about gaps in contraceptive coverage attributable to medical management policies, 21 the Department of Health and Human Services HHS issued new guidance in May which clarifies that at least one form of all 18 FDA-approved methods of birth control must be covered without cost-sharing. If a provider recommends a specific option or product, plans must cover it without cost-sharing as well. Insurers may use reasonable medical management, however, to limit coverage to generic drugs when a generic version exists, and can impose cost-sharing for equivalent branded drugs. Exempt employers do not have to include contraceptive coverage for their workers and their dependents in their health plan.
The health carrier used by the nonprofit employer or closely held for-profit employer must notify the policyholders, and provide separate coverage of contraceptives, at no cost, to the policyholders. Unlike an exemption, female employees and the female dependents covered by the plans of a nonprofit or closely held for-profit employer choosing an accommodation are entitled to the full contraceptive coverage from their insurance carrier. Looking Forward Today, millions of women now have coverage for the full range of contraceptive methods without cost-sharing; however, some women will continue to experience gaps in coverage. Federal and state regulators have an important role to play in ensuring the federal standards are applied accurately and fairly, meaning all women can access contraceptive services.
Orxl Maythe Supreme Court remanded Zubik v. Burwellsending 7 cases brought by religious nonprofits objecting to the contraceptive coverage accommodation back to the respective Courts of Appeal. Awareness of the Federal Standard Among Women and Providers A recent HHS study estimates that 55 million women have private insurance coverage that includes no-cost coverage for contraceptive services and supplies. Role of States in Expanding Coverage States have historically regulated insurance and many have mandated minimum benefits for foverage. Contraceptive coverage is no exception. Since the passage of the ACA, some states have Insugance to strengthening and expanding the federal contraceptive coverage requirement.
For example, in California passed the Contraceptive Coverage Equity Act of which requires plans to cover prescribed FDA-approved contraceptives for women without cost-sharing. The law specifies that a plan does not have to cover more than one therapeutic equivalent of a contraceptive drug, device, or product, as long as at least one is covered without cost-sharing. Contraceptives with the same chemical formulation and delivery mechanism are therapeutically equivalent. InOregon passed a law that requires insurers to pay for a 3 month supply of contraceptives when first prescribed, followed by a 12 month supply of contraceptives regardless of whether the woman was insured by the same plan at the time of the first dispensing.
The patient requested that Kidd fudge why she needed it. Wendy Norman, a physician at the University of British Columbia, whose focus is on family planning. The choice to not cover birth control is a bad one, she says, both for the company and for the woman. Numerous studies, by the Guttmacher Institute and others, says Norman, have found that women with unplanned children are less likely to finish their education and less likely to advance in their careers. Norman also thinks that covering only the birth control pill and excluding devices is wrong-headed. We need a rational process.