(Oct. 25, 2022)—”Today, Rep. Carolyn B. Maloney, the Chairwoman of the Committee on Oversight and Reform, released a staff report entitled, Barriers to Birth Control: An Analysis of Contraceptive Coverage and Costs for Patients with Private Insurance. The report presents findings from the Committee’s review of birth control coverage offered by five of the nation’s largest health insurers and four of the largest pharmacy benefit managers (PBMs). The Affordable Care Act (ACA) requires issuers and health plans to cover Food and Drug Administration (FDA)-approved contraceptive products without cost-sharing. On May 26, 2022, following reports that patients were facing barriers to accessing birth control without cost-sharing, Chairwoman Maloney sent letters to health insurers UnitedHealth, Anthem, Aetna, Cigna, and Humana and pharmacy benefit managers CVS Caremark, Express Scripts, OptumRx, and Prime Therapeutics, requesting information regarding zero-cost coverage of contraceptives and related services for individuals enrolled in private health plans, as required by the ACA. The Committee’s investigation identified more than 30 birth control products for which most health insurers and PBMs reviewed impose cost-sharing requirements or coverage exclusions. The investigation found that the processes established for patients seeking exceptions to cost-sharing and coverage restrictions can be burdensome for patients and providers, and that from 2015 to 2021, companies denied exceptions requests on average four or more times out of ten. These practices raise barriers to accessing birth control, contrary to Congress’s goal in the ACA…”
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