HHS Mandates Copay-Free Contraception, With Exceptions


Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually–transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013.

The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released earlier this summer. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

The list of preventive services was recommended by an expert panel of the Institute of Medicine.

In a report released July 19, the IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

Dr. E. Albert Reece commented, “The charge of the Preventive Services for Women committee, of which I was a member, was to identify the 'gaps' in coverage that could potentially have a major impact on the health of women in this country. Our other charge was to make recommendations regarding only those preventive services where there was an extremely high level of scientific evidence supporting their health benefits.

“Thus, all of the recommendations we made were based on a very strong scientific evidence of a clear health benefit, as well as evidence from many sources that, if implemented, would fill a significant health care gap in providing optimal preventive care for women. Contraception was just one of a handful of preventive services that emerged from this very rigorous process out of the many services that we considered.”

He continued, “Unintended pregnancies are a major cause of preterm births in this country, and preterm birth is a major contributor to infant mortality and fetal health problems. Despite strong evidence to support the use of contraceptives to ameliorate preterm births, we found a significant gap in access to and availability of this highly effective preventive method.

“As physicians and public health professionals, we on the IOM committee would have been ethically and morally remiss if we had omitted a recommendation to provide a service – without any barriers to access – that can potentially prevent this incredibly costly public health problem,” Dr. Reece, vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of its school of medicine, said in an interview.

In a press briefing, IOM panel chair Linda Rosenstock, dean of the University of California, Los Angeles, noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician.

However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”


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