WASHINGTON – Women are generally experiencing better access to contraception thanks to the Affordable Care Act, but more needs to be done to ensure that health plans aren’t implementing overly restrictive policies, according to a new report from the Kaiser Family Foundation.
As part of the ACA, most private health plans are required to provide no-cost coverage of women’s preventive health care, including all prescription contraceptives approved by the Food and Drug Administration. The federal guidance issued on preventive services coverage requirements, however, adds that plans can apply reasonable medical management techniques to “control cost and promote efficient delivery of care.”
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The April 16 Kaiser Family Foundation report, which examines contraception coverage trends in five states, found that, since the provision became effective in August 2012, “there have been ongoing anecdotal reports of some women experiencing difficulties in securing no-cost coverage from their plans.”
Although Kaiser researchers found that most insurance carriers “are complying with the spirit of the contraceptive coverage requirement, there are some exceptions that appear to be attributable to the carriers’ interpretation of the [Health & Human Services department] regulations.”
During a panel discussion on the report, Dr. Peggy Peng Ye, an ob.gyn. at Medstar Washington (D.C.) Hospital Center, said the finding mirrors what she is seeing in her practice.
“I think this really confirms our experience in that the contraceptive mandate is really working well,” Dr. Ye said. “There are certainly some small pockets where there’s kind of idiosyncratic methods that really aren’t covered for kind of strange reasons that don’t necessarily have a real medical basis. But overall I think that it’s made a great impact.”
The report focused on 12 contraceptive methods, excluding oral contraceptives, and found a wide variation between 20 carrier offerings in the five states (California, Georgia, Michigan, New Jersey, and Texas).
For example, the vaginal ring NuvaRing was covered by 12 of the 20 insurance carriers without any medical management limitations or cost sharing. The remaining carriers, however, varied in their approaches, with some covering the ring with cost sharing, while others had no cost sharing but applied step therapy. One plan offered no coverage of the ring.
The rationale from plan officials for applying cost sharing to the NuvaRing was that contraceptives with the same progestin are equivalent to each other regardless of the delivery method, according to the report. Since the plan has no cost sharing for oral contraceptives, which have the same chemical composition, they decided to impose cost sharing for the NuvaRing.
Wider variations were seen for injections, implants, intrauterine devices (both hormonal and nonhormonal), emergency contraceptive pills, and sterilization.
The Kaiser researchers also raised concerns about the lack of an expedited waiver or appeals process in cases for which emergency contraception is not covered or cost sharing is required. None of the carriers interviewed for the report had an expedited process other than the expedited appeal process required for all other benefits, “which may not be timely enough for women seeking emergency contraceptives,” according to the report.
Ms. Gretchen Borchelt, vice president for health and reproductive rights at the National Women’s Law Center, called the ACA provision requiring contraception “a huge game changer.”
“Millions of women with private insurance now are able to choose the method of birth control that is best for them without having to factor cost into the equation. That makes a huge difference,” Ms. Borchelt said. “But, on the other side, what your report finds is basically what we know to be true, that there are still some women who are not fully benefiting from this tremendous advance for women’s health.”
She called on state and federal regulators to step up enforcement of the contraception coverage requirement.
The report’s lead author, Ms. Laurie Sobel, senior policy analyst for women’s health policy at the Kaiser Family Foundation, suggested that clearer guidance on coverage would help to limit some of the variation. She pointed to a 2014 law in California that more clearly defines coverage of FDA-approved contraceptive products as a template.