FAQs Issued for Contraceptive Coverage Mandate

1 minute read

The Departments of Labor, Health and Human Services, and the Treasury (Departments) issued FAQs about the contraceptive coverage mandate under the Affordable Care Act (ACA). The FAQs clarify the mandate's scope, discuss noncompliance, and introduce a new optional approach for covering FDA-approved contraceptives.

Contraceptive Coverage Mandate

The ACA mandates that health plans and issuers cover preventive care services without cost sharing, including contraceptives outlined in Health Resources and Services Administration (HRSA) guidelines. Exemptions are available for religious and eligible employers with objections.

Noncompliance Reports

The Departments are aware of reports of widespread barriers to contraceptive coverage, including unreasonable medical management techniques. Examples include step-therapy protocols, age-related restrictions, burdensome administrative requirements, and cost sharing for integral services.

New Optional Approach

To address compliance problems, the FAQs describe a new optional approach called the therapeutic equivalence approach. This approach allows health plans and issuers to cover all FDA-approved contraceptive drugs and devices without cost sharing, except for those with therapeutic equivalents. It also provides an exceptions process for individuals to access medically necessary therapeutic equivalent products without cost sharing.

This new approach may apply to employers’ coverage of contraceptive drugs and drug-led devices. Employers should review their health plan’s contraceptive coverage for compliance with the ACA mandate. Download the bulletin for more details.