Contraception access is a legal right: It’s time for insurers to comply

Through the beauty of scientific research and development, women now have many contraceptive options that enable them to choose the product that meets their specific health needs. The best option varies from woman to woman based on their lifestyle, schedule, medical history and the medications they are already on. These options have transformed and advanced the lives of women and their ability to make decisions about their own well-being. 

The more than 72 million American women of reproductive age in the U.S. have a wide variety of reasons for using birth control. The Affordable Care Act (ACA), signed into law in 2010, includes explicit protections for access to contraception, ensuring that women receive it at no cost under their health insurance plan. 

The ACA contraceptive provision aimed to level the playing field for women regardless of income, insurance or ZIP code by safeguarding access to the contraceptive method that they and their provider determined was best in consultation with each other. Yet, to this day, women across the country are still not able to access the contraception they need, were prescribed and are entitled to at no cost. 

Why? Many insurers and pharmacy benefit managers are not complying with ACA’s legal requirements to provide free access to the full range of FDA-approved contraceptives. Instead, they routinely deny coverage, requiring individuals to try other contraceptive methods prior to permitting coverage for the desired method; charge exorbitant copays and impose overly burdensome medical management techniques beyond those permitted by the law and fail to establish an easy waiver process. These actions have the potential to impact women who are entitled to no-cost contraception under their healthcare plan. 

Finding the right contraception is a highly personal process. It is also one many women revisit throughout their lives. In fact, about 72 percent of women have used more than one type of contraception in their lifetime. On average, women report using 3.4 methods. The decision about what kind of birth control is best for any particular woman is one that only she can make with her provider. Insurance companies have no place in this discussion, though their frequent denials of coverage indicate they believe otherwise.

The ACA requires plans and issuers to cover each form of FDA-approved contraceptive that a patient’s provider determines is necessary. While insurers and pharmacy benefit managers may implicitly steer patients to use certain types of contraceptives, if a provider determines in consultation with their patient that a specific form of birth control is necessary for that patient, the plan must cover it without cost-sharing, whether it has before or not. 

The impact of this practice is twofold: One, it will ultimately limit women to products of the past even though newer ones may be more effective at preventing unplanned pregnancies and be better for a particular patient overall. Two, it creates a significant cost for patients who are supposed to be getting contraception at no cost.  

In the first year of the ACA, women saved $1.4 billion in out-of-pocket costs, and, on average, each woman saved $255 every year. Now, with insurance providers refusing to comply with ACA mandates, many are not seeing these benefits. 

These barriers are extremely cumbersome for women. They will also inevitably lead to unintended pregnancies — a significant and costly public health issue — and of course, impact women’s lives. Women need access to their provider-recommended contraceptive method at no cost, expeditiously, without barriers and in keeping with the law. 

The Department of Health and Human Services, Department of Labor and Treasury Department have taken a bold, brave and much-needed first step to address the systematic non-compliance by insurers and plans. They reaffirmed the law earlier this week by issuing new guidance.

We must now hold insurance companies accountable in adhering to this guidance, nothing less than women’s basic rights and good health are at stake.

Martha Nolan is senior policy advisor at HealthyWomen, a nonprofit that educates women to make decisions about their health care.