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Some Insurers Charging Copays for Generic Contraceptives Under ACA

Some Insurers Charging Copays for Generic Contraceptives Under ACA

February 6, 2015 — Some insurers that are subject to Affordable Care Act (PL 111-148) rules requiring coverage of all FDA-approved contraceptives without cost-sharing are charging their members copayments for some generics, Kaiser Health News reports.

KHN cites an example of an insurer that moved a woman's generic birth control from a tier in the plan's drug formulary that requires no copay to another tier requiring $19 per month in cost-sharing (Andrews, Kaiser Health News, 2/6).

Federal guidance on the contraceptive coverage rules states that most insurers must cover the full range of FDA-approved methods without cost-sharing. Insurers are permitted to use "reasonable medical management techniques" to curb costs, such as only covering the generic version of an approved contraceptive (Women's Health Policy Report, 8/22/14).

However, that does not mean that an insurer can charge for certain generics simply because it offers others without copays, according to Adam Sonfield, senior public policy associate at the Guttmacher Institute.

Sonfield said, "All generics aren't the same. All of the different [generic] formulations should be on the zero [cost-sharing] tier, but that isn't clear in the current guidelines." Some insurers also have argued that they should not have to cover the contraceptive patch or vaginal ring because the same hormones are used in birth control pills, KHN reports. However, HHS officials have said that because they are different types of methods, they all must be covered (Kaiser Health News, 2/6).