Amid Reports that Insurers Are Flouting ACA Contraception Coverage Protections, Senators Murray, Wyden Urge Biden Administration to Protect Access to Birth Control

Senators Murray, Wyden to Biden Administration: “We have heard alarming reports that insurers are flouting the ACA’s contraceptive coverage protections, threatening women’s health and economic security … Your robust enforcement of the ACA’s contraceptive coverage requirement is vital to the women who rely on its protection.”

(WASHINGTON, D.C.) – Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Senator Ron Wyden, Chair of the Senate Finance Committee, pushed to end barriers patients face in getting their birth control covered by insurance without cost-sharing—which still persist despite the Affordable Care Act (ACA) contraception coverage protections.

In a letter to Secretary of Health and Human Services (HHS) Xavier Becerra, Secretary of Labor Marty Walsh, and Treasury Secretary Janet Yellen, the Senators pushed the Biden Administration to make clear to insurers their responsibility t0 provide birth control coverage without out of pocket costs for patients—and take enforcement action against those that do not comply.

“We are writing to express our concern about reports that insurers are imposing unlawful barriers to birth control coverage. The Affordable Care Act (ACA) requires insurers to cover birth control without cost sharing and provide coverage to the full range of Food and Drug Administration (FDA) approved and cleared contraception. However, we have heard alarming reports that insurers are flouting the ACA’s contraceptive coverage protections, threatening women’s health and economic security,” wrote the Senators.

“We therefore ask that you issue additional, comprehensive guidance regarding insurers’ responsibilities for contraceptive coverage and that you take swift enforcement action against insurers who fail to comply with those responsibilities. Your robust enforcement of the ACA’s contraceptive coverage requirement is vital to the women who rely on its protection.”

Senators Murray and Wyden have heard alarming reports from patients and providers that some insurers are requiring patients to show they have failed with as many as five different birth control options before the insurer will pay for the method of their choice. Everyone should be able to access the birth control that works best for them—without having to jump through hoops or face unnecessary burdens. In their letter, they made clear to the Administration that these reports raise serious concerns that insurers are flouting the ACA, and that swift action is needed to protect patients’ reproductive health and ensure they get the full protections of the law.

The full letter can be found HERE and below.

December 9, 2021

Dear Secretary Becerra, Secretary Yellen, and Secretary Walsh; 

We are writing to express our concern about reports that insurers are imposing unlawful barriers to birth control coverage. The Affordable Care Act (ACA) requires insurers to cover birth control without cost sharing and provide coverage to the full range of Food and Drug Administration (FDA) approved and cleared contraception. However, we have heard alarming reports that insurers are flouting the ACA’s contraceptive coverage protections, threatening women’s health and economic security. As the Health Resources and Services Administration undertakes action related to updating the Women’s Preventive Services Guidelines, we ask you to issue new guidance to clarify payers’ responsibility to provide coverage of birth control without cost-sharing and to take enforcement action against any insurance issuers or health plans failing to comply with the requirements under the ACA.

The ACA increased access to birth control for women across the country. As of November 2020, over 64 million women had coverage for contraception without out-of-pocket costs.^[1] Guidance issued in 2015 specifically required plans to “have an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider.”^[2] The guidance also makes clear that insurers must defer to recommendations from providers when making a determination of medical necessity when it comes to birth control.^[3] The objective of this exceptions process is to prevent insurers from using cost control tools that prevent women from accessing their preferred method of birth control.

Unfortunately, we have heard from patients and providers that some insurers are requiring patients to show they have failed with as many as five different birth control options before the insurer will pay for the method of their choice. Reports of denials and unclear exemptions processes raise concerns about whether patients are actually getting coverage for birth control without cost-sharing as required by the ACA.

We therefore ask that you issue additional, comprehensive guidance regarding insurers’ responsibilities for contraceptive coverage and that you take swift enforcement action against insurers who fail to comply with those responsibilities. Your robust enforcement of the ACA’s contraceptive coverage requirement is vital to the women who rely on its protection. We appreciate your ongoing commitment to this goal and look forward to continuing to work together to achieve it. Thank you in advance for consideration of this request.

Sincerely,

Patty Murray

United States Senator

Ron Wyden

United States Senator

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