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Dozens of Democratic lawmakers are urging the Biden administration to require private health insurance plans to fully cover the first over-the-counter birth control pill in the United States, which is expected to hit stores starting early next year.
The United States Food and Drug Administration approved the drug Opill in July, making it the first daily oral contraceptive approved for use without a prescription in the United States. This over-the-counter birth control pill, which contains only the hormone progestin, is expected to be available at pharmacies, convenience and grocery stores, as well as online.
It’s still unclear exactly what Opill’s retail price will be, and in a letter obtained by CNN, several dozen Democratic senators are calling on federal agencies to guarantee that private health insurance plans will fully cover the pill without a prescription. The letter, sent Monday morning, was addressed to Health and Human Services Secretary Xavier Becerra, Treasury Secretary Janet Yellen and Labor Secretary Julie Su.
“Over-the-counter contraceptives have the potential to be a game-changer for many women, but only if they are truly affordable. The Biden administration can and should do everything it can to get us there, and one major step it can take is to require insurance companies to cover over-the-counter contraceptives without cost or prescription,” said Washington Senator Patty. Murray, the letter’s author, said in an email.
“As someone who worked to pass the Affordable Care Act that required free birth control coverage, I see no reason why the ACA’s coverage mandate wouldn’t also apply to birth control. FDA-approved over-the-counter births,” she said. . “And since over-the-counter contraceptives may very well become the most convenient contraceptive option for many women, it is even more important that we ensure they are fully covered.”
In the letter, Murray — along with Vermont Sen. Bernie Sanders, Oregon Sen. Ron Wyden, Wisconsin Sen. Tammy Baldwin and 44 of their Senate colleagues — asked the heads of the U.S. Departments of Health and Human Services Social, Treasury and Labor to take “additional actions” to ensure coverage of over-the-counter contraceptive products without cost sharing or the need for a prescription. These three departments have the authority to require plans covering over-the-counter contraception.
“The FDA’s approval of Opill is an important milestone; However, for an over-the-counter birth control pill to reach its potential and be truly accessible, federal departments must ensure that it is covered without cost sharing and without the need for a prescription as a condition of coverage,” the lawmakers wrote in their letter.
The letter noted that additional training and billing guidance for pharmacists and other health care providers would assist in these efforts to expand access to over-the-counter contraceptives like Opill.
“To expand access to affordable contraception, we urge all three departments to issue new guidance that mirrors current HRSA guidance and clarifies that federally and state-regulated private health plans must cover the products over-the-counter contraceptives without cost sharing, including when purchased without a prescription. ” the lawmakers wrote, referring to the directives of the Health Resources and Services Administration that currently does not include a prescription requirement For contraceptive coverage. “We ask you to do this as soon as possible.”
As for the price of Opill, a representative for Perrigo, the drug’s manufacturer, said in an email Thursday that “the on-shelf price of Opill will be at the sole discretion of each retailer.” Perrigo has not disclosed the manufacturer’s suggested retail price at this time. We are committed to ensuring Opill is accessible to people who need it, and more details will be shared in the coming months.
Currently, federal law requires most private health insurance plans and Medicaid expansion programs to cover the full range of FDA-approved contraceptive methods, but for this coverage, health plans typically state that a prescription is required – and this coverage varies from state to state.
In October, at least Six states have passed laws requiring health plans to cover certain oral contraceptives without a prescription and without cost sharing, according to a report. report published last month by the non-profit association KFF.
But in theory, if all three federal departments — HHS, Treasury and Labor — require private health insurers to fully cover over-the-counter contraceptives without a prescription, “that could certainly impact access across the United States.” and make this coverage more uniform. ” said Michelle Long, author of the KFF report and senior policy analyst for women’s health policy at KFF.
In June, President Biden issued a decree direct administration officials to consider new ways to improve access to affordable over-the-counter contraceptives and consider new guidance to ensure that private health insurance under the Affordable Care Act covers all FDA-authorized contraceptives without cost sharing.
Then earlier this month, the Treasury, Labor, and HHS departments issued a “information request» to gather public comment regarding the potential benefits and costs of requiring coverage for over-the-counter preventive services, including contraception. The public can submit comments until December 4.
These public comments will help inform the rules regarding extending coverage requirements to over-the-counter preventative products and services, including oral contraception.
“It’s one thing to put a law on the books. It’s a completely different matter to understand the mechanics of the system and how to make it operational,” Long said. “Obviously, cost is an important part of access and the reach and effectiveness of this over-the-counter pill really depends on insurance coverage. »
Biden administration officials convened a meeting with private sector leaders — including insurers and pharmacies — on Friday to discuss efforts to ensure access to affordable, high-quality contraception. Many of these same organizations are responding to the “demand for information,” said Jennifer Klein, assistant to the president and director of the Gender Policy Council.
“The first daily oral contraceptive will be available over the counter and we must ensure that the private sector as well as government actors are doing everything they can to ensure that this contraceptive product gets into the hands of people who need it. I need it,” Klein said. “We are exploring all options to ensure access.”
Without a federal requirement that private health insurers fully cover over-the-counter contraceptives, consumers wishing to use Opill will have one of two options: pay the retail price of Opill out of pocket or be prescribed a pill comparable contraceptive. by their provider at no cost because they would be covered by their insurance, said Dana Singiser, a health care policy expert and co-founder of the advocacy nonprofit. Contraceptive Access Initiative (CAI).
“On one hand, if you get a prescription, then your contraception is covered by ACA insurance. But if you buy it over the counter at a retail store, it’s not covered,” Singiser said. “So it makes no sense for a contraceptive product to be covered when you buy it off the shelf rather than when you get it with a prescription, when it has exactly the same health benefits. »
Singiser’s organization, CAI, supports the lawmakers’ letter, she said, adding that equitable access to contraception is even more important now, following the Supreme Court’s Dobbs decision last year to overturn Roe v. Wade in the United States, which overturned constitutional law. to an abortion.
“We are working to remove the unnecessary barrier to prescribing oral contraceptives, which Opill did by obtaining FDA approval to sell its product over-the-counter. We also need to address the affordability issue by ensuring that Opill and other forms of over-the-counter contraception are covered by insurance,” Singiser said.
“We can only truly achieve fully equitable access if we address both the barriers to prescribing and the affordability of Opill,” she said. “Following the Dobbs decision, policymakers must do everything possible to make contraception more affordable for pregnancy prevention, for personal autonomy, and for all of the health benefits that contraception offers. »
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In her email, Senator Murray said the Dobbs decision had led to a “health care crisis” and was among the factors making the push for birth control “accessible and affordable” even more more urgent now.
For decades, Murray has pushed for affordable and accessible birth control, and last year, before Opill’s endorsement, she introduced the Accessibility Act is access. — reintroduce it in May – which would ensure that insurers fully cover over-the-counter contraceptives without any fees or out-of-pocket costs.
“The Dobbs This decision has sparked a real health care crisis across the country – and in the wake of this disastrous decision that has made pregnancy more dangerous and left so many women suffering, it is more important than ever to ensure that birth control be as accessible and affordable as possible,” Murray said in his email.
“The truth is that we’ve always had to fight tooth and nail, and really speak out about that fight, to provide women with contraception and basic reproductive health care that they can actually afford. she said in part. “This time is no different.”
