October 21, 2024
Over the counter contraceptives – yes – even the specific brand you prefer — could soon be completely free and may not need a prescription. That’s according to a rule the Biden administration is proposing today for not only the affordable care act insurers – but also for private health insurance companies.
The Affordable Care Act mandates all health insurance companies cover contraception at no cost, but plans are not required to cover items available over the counter unless the patient has a prescription. On top of that the ACA requires most heath insurance to cover only one drug per category of contraception. But if this rule is finalized that would all change.
The proposed rule would require your insurer to cover recommended over the counter contraceptive items without a prescription and without any cost-sharing– that means no copays, co-insurance, no out of pocket charges for things like emergency contraception, condoms and IUDs.
The proposed rule would also require health insurers to make more brand choices of prescribed contraceptives available to you at no cost. Currently – as I said before the ACA only requires insurers to cover one drug per contraceptive category – so if the brand of pill you want to use is not the one that your insurance covers, then you’re out of luck. But this new proposed rule would require every single FDA approved contraceptive drug or drug-led combination product to be made available with a prescription with no cost sharing unless the insurance covers a therapeutic equivalent.
And lastly this proposed rule would require health insurance companies to inform you that this benefit exists.
How exactly this is all implemented is still up for discussion. Like – will you have to purchase the contraceptive and then be reimbursed by your insurance? Or will these items be available at your local pharmacies and you have to go to the counter. That’s what the rule making process is going to sort out.
Now you have to understand this will not change immediately, this rule has to go through the full 60-day comment period and if it’s approved and finalized, the proposal says this would be available for health plans starting on or after January 1 2026.
Read more from the White House on this proposed rule here.
Read more from HHS about this proposed rule here.
