The initiative comes after years of systemic failure by insurance plans and women having to pay out of pocket or face administrative red tape to access contraception.
Washington DC — U.S. Representative Abigail Spanberger today joined more than 150 colleagues in the U.S. House of Representatives and the U.S. Senate to improve access to contraception through full coverage of all contraceptives without generic equivalents. I complained to the medical insurance company.
of Affordable Medical Care Act (ACA) requires insurance companies to cover contraception for free. Despite these protections, plans routinely violate the ACA by denying coverage of certain products, imposing administrative hurdles, and requiring unacceptable cost-sharing. This has been revealed in multiple studies. In response to these violations, the Biden administration recently issued additional guidance outlining standards that require no-cost coverage for all FDA-approved products that do not have generic equivalents.
In a letter to America's Health Insurance Plans (AHIP) and UnitedHealth Group, whose members include major health insurance companies across the United States, Spanberger and his colleagues urge health insurance companies to comply with the law and provide insurance coverage. They called for the immediate adoption of “therapeutic equivalency standards'' that would allow application. You don't have to pay for all FDA-approved birth control products that don't have generic or “therapeutic” equivalents. Their letter points to years of systematic non-compliance by insurance plans, forcing women to pay out of pocket or face administrative red tape to access the contraceptive method that works best for them. It was issued in response to the situation that has been forced upon us.
“We are writing to express our concern that your members are not complying with our terms and conditions. Affordable Medical Care Act Establishes coverage requirements for contraception and urges consideration of immediate adoption of the therapeutic equivalence standards outlined by the Departments of Health and Human Services, Labor, and Treasury on January 22, 2024. ” Spanberger and colleagues write: “Despite repeated clarification of these requirements from departments, multiple investigations, including the House Oversight Committee, have found that plans deny coverage of certain products and require prior authorization or step therapy (fail-fast protocols). It has become clear that the ACA is routinely violated by imposing administrative hurdles such as “and requiring patient costs.'' ”
Their letter continued as follows: “As required by the ACA, we urge your plans to immediately consider implementing treatment equivalence standards to ensure patients have access to the contraceptives they need.”
This letter is supported by Planned Parenthood Federation of America, Reproductive Freedom for All (formerly NARAL), Right to Decide, and Physicians for Reproductive Health.
“Under the Affordable Care Act (ACA), comprehensive coverage of contraception is the law, not a proposal. Yet insurance companies are blatantly ignoring this important provision.” said Gretchen Borchert, deputy director for reproductive rights and health at the National Women's Law Center. “We support reproductive health advocates in the House and Senate in calling for immediate action. The time has come to ensure coverage. We urge them to adopt the therapeutic equivalence standards outlined by the Departments of Health and Human Services, Labor and Treasury.”
“New guidance from the Biden-Harris administration is urgently needed. We remain vigilant in promoting plan compliance with the ACA contraceptive coverage requirements and holding violators accountable.” Thank you to our advocates in Congress for continuing to do so.” “We are thrilled to be partnering with Power to Decide,” said Power to Decide CEO Regan McDonald Mosley, MD, MPH. “As a practicing obstetrician-gynecologist, I know how frustrating it is for patients when their health insurance doesn't cover the contraceptives they need. Find the contraceptive method that's right for you. It takes time, and insurance denial of the method is a major barrier that often prevents people from getting the contraception they need.”
The letter was led in the Senate by Sen. Elizabeth Warren (D-MA), Sen. Catherine Cortez Masto (D-NV), and Sen. Tina Smith (D-MN), and in the House by Royce -Led by Representative Frankel (D-Minnesota). FL-22), Ayanna Pressley (D-MA-7), Kathy Manning (D-NC-6), and Judy Chu (D-CA-28).
click here Please read the letter. The full text of the letter is below.
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Dear Mr. Tuffin:
We express concern that our members are not complying with the contraceptive coverage requirements of the Affordable Care Act (ACA), and we are announcing the immediate implementation of treatment equivalency standards outlined by the Department of Health and Human Services, the Department of Labor, and the Department of Health and Human Services. I wrote this letter to ask you to consider hiring me. Ministry of Finance on January 22, 2024.
As you know, the ACA requires plans to fully cover all contraceptives approved, licensed, or cleared by the Food and Drug Administration (FDA). Previous guidance clarified that plans must cover at least one form of each contraceptive method at no cost-sharing, and if a plan does not cover the specific product a patient needs, a simple They also needed an exception process that was accessible, painless, and transparent.
Despite these requirements having been repeatedly clarified by departments, multiple investigations, including the House Oversight Committee, have found that plans deny coverage of certain products and require prior authorization, step therapy (fail-fast protocols), etc. has been found to routinely violate the ACA by imposing administrative hurdles. Patients also need to bear the cost.
In response to this systemic noncompliance, the Departments issued additional guidance on January 22, 2024, outlining standards that require no-cost coverage for all FDA-approved products for which there is no equivalent treatment. Indicated. If a therapeutically equivalent product exists, a plan may choose to cover only one therapeutically equivalent product, as long as it maintains an acceptable exception process if a patient needs a particular product. Departments generally consider plans that adopt this standard to be compliant with federal law, essentially establishing a “safe harbor” for issuers. Additionally, although the exception process should be used much less frequently, this process has never worked for consumers and providers and remains a significant compliance issue for payers.
As required by the ACA, we urge your plans to immediately consider implementing treatment equivalence standards to ensure patients have access to the contraceptives they need. We request answers to the following questions by March 21, 2024.
- Does your plan plan to adopt treatment equivalence standards, and how soon?
- For plans that decline to adopt treatment equivalence standards, how do they ensure compliance with ACA contraceptive coverage requirements, and over what time frame?
- Does your plan employ administrative practices that the Departments have explicitly cited as violating the ACA, and how will you eliminate these barriers?
- Do all your plans have published exception processes? Where are they available on the website?
Thank you for your attention to these issues. We look forward to your reply.
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