Raskin presses insurers, PBMs on free contraception coverage

The top Democrat on the House Oversight and Accountability Committee wants to know how the country’s top health insurers and pharmacy benefit managers plan to make it easier for people to access contraception for free.  

In letters sent Thursday to the five largest health insurers and four largest pharmacy benefit managers first shared with The Hill, Rep. Jamie Raskin (D-Md.) asked for information on how the companies plan to respond to federal guidance designed to improve no-cost access to birth control. 

Adopting the guidance “is vital to ensuring that millions of women of reproductive age have increased access to no-cost contraception—something that is particularly important as Republicans continue to enact stringent bans on abortion across the country,” Raskin said in the letters. 

The letters were sent to Aetna, Cigna, Elevance Health, Humana, United Healthcare, CVS Caremark, Express Scripts, Optum Rx and Prime Therapeutics. The Hill has reached out to all of the companies for comment.

The guidance from federal health officials in January encouraged insurers to cover without cost-sharing all Food and Drug Administration-approved contraceptive products that do not have a therapeutic equivalent. 

The guidance would allow health plans and PBMs to prioritize the use of generic pharmaceuticals where possible, while ensuring that patients have access without cost sharing to products that do not yet have a generic version. 

In all 50 states, the Affordable Care Act guarantees coverage of women’s preventive services, including free birth control and contraceptive counseling. There are 18 contraceptive methods approved by the Food and Drug Administration, but the law requires insurers to cover only one product per category.  

A 2023 staff report from Raskin’s office found that many patients covered by five of the largest health insurers and four of the largest PBMs impose coverage exclusions and other restrictions on birth control products, contrary to the ACA.