Goat Friends (frolicnaked) wrote in vaginapagina,
Goat Friends

More Fine Print on Affordable Care Act & Contraception Coverage

[Just as a heads up, this info = US-centric.]

I found this Slate article via Feministing and thought it might be relevant to VPers, particularly those who've been looking forward to not having copays for prescription contraception.

Short version: While insurance companies have to cover all methods of FDA-approved contraception (e.g., pills), they don't have to cover all brands of a particular method.

From the article:
Not all birth control is covered. While the HHS website describes the benefit as applying to, "All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity," "all" is a word that's subject to interpretation—as I learned yesterday when I waltzed into the pharmacy expecting to not pay a cent but still had to fork over $50 to get my pills. All kinds of birth control are covered—pills, rings, injections, IUDs, diaphragms, emergency contraception—but not all brands. Insurance companies have a lot of leeway within the regulation to refuse to cover certain brands. For brands that have a generic version, the company can choose to only offer the generic for free. For certain brands that don't have a generic, they can refuse coverage, requiring the patient to get a new prescription for a different brand that is within the company's parameters.

Assuming the article is accurate (I'm unable to find clarification either way on the HRSA and related websites), it appears that an insurance provider can choose not to cover particular brands of oral contraceptives. I'm less clear on whether they can consider methods like Nuva Ring and Ortho Evra to be the "same" type of method as combined-hormone oral contraceptives (an argument my insurance companies have made in the past) or whether those must be considered different methods and therefore covered (I would hope so, as some folks have contraindications for oral BC). Similarly, I'm not even sure if this means insurers must cover both hormonal and non-hormonal IUDs (though I would hope so in this case even more than for the patch and the ring -- as the contraindications for each are quite different and pronounced).

Anyone able to dig up additional info? (If you happen to have the time and inclination, I mean.) For now, I'm off to see what my own BC pills will cost me.

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