The Biden Administration – through the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (Treasury) – proposed a new rule to build upon the Affordable Care Act (ACA) by expanding access to coverage of recommended preventive services without cost sharing in the commercial market, with a particular focus on reducing barriers to coverage of contraceptive services, including over-the-counter (OTC) contraceptives. The rule, if finalized, would represent the most significant expansion of contraception coverage under the Affordable Care Act since 2012, when contraception was first required to be covered. The pre-publication text of the proposed rule can be accessed here, along with a fact sheet from the White House, and a fact sheet from the Centers for Medicare and Medicaid Services.
Among other things, the proposed rule would: (1) expand coverage of OTC contraception without cost-sharing, which would allow women to obtain OTC contraception – including daily pills, emergency contraceptives, and condoms – without a prescription at no additional cost for the first time; (2) require private health plans to disclose that OTC contraception is covered without cost sharing and without a prescription and to take steps to help women learn more about their contraception coverage; and (3) require health plans to cover every FDA-approved contraceptive drug or drug-led combination product without cost sharing unless the plan also covers a therapeutic equivalent without cost sharing, eliminating barriers that some women continue to face in accessing contraception prescribed by their provider.
The Departments also released additional guidance addressing plans’ and issuers’ coverage of other recommended preventive services, as required under the ACA. This guidance focuses on, among other things, coverage of pre-exposure prophylaxis (PrEP), a type of medication that reduces the risk of HIV infection, and certain provisions under the Women’s Health and Cancer Rights Act.