Thanks to the Affordable Care Act (the ACA or Obamacare) health plans are required to cover many women’s preventive services, including birth control, without copays or deductibles. However, a new Kaiser Family Foundation study of health plans and their birth control coverage found that some plans are utilizing “medical management” for some birth control methods, often resulting in barriers for women accessing the method that has been prescribed to them by their health care provider. Examples of medical management used by plans includes placing some methods into cost-sharing “tiers,” requiring that providers give pre-authorization for a prescription before covering it, and in some cases requiring that a covered method “fail” before covering a woman’s preferred method.
At a briefing held yesterday at the Kaiser Family Foundation, panelists discussed the implications of the study and the potential harm when medical management becomes an obstacle for women accessing birth control. One panelist – an insurance plan representative – described the logic behind this type of medical management as “indefensible.” Our own Gretchen Borchelt, VP for Health and Reproductive Rights at the National Women’s Law Center (NWLC), drove home the importance of compliance by health plans, by explaining that these are not just problems or barriers, but are violations of the law.
Insurance coverage of birth control without copays or deductibles has been a game-changer for women’s health and economic security. Most women are getting their birth control covered without copays or deductibles, and many women now have access to more effective but costly methods like IUDs. Yet, news stories abound from women who were charged copays for their birth control.
At NWLC’s CoverHer hotline, we’ve heard from and helped women in every state who’ve had issues with coverage of every kind of method, from the pill to the ring to the IUD to sterilization. We too have seen the burdensome hoops many women are expected to jump through to get the health coverage they pay for through their premiums – including only covering generic pills, excluding all other methods, or grouping the NuvaRing into the same category as the pill, even though it is recognized [PDF]as a separate method.
As Gretchen explained at yesterday’s panel, women understand that taking a pill, putting on a patch, or putting a ring in her vagina are different birth control methods. Women understand that “all FDA-approved birth control methods” means what it says – all methods should be covered without copays, without deductibles, and without hassle. The question remains, why is this so elusive to health plans?