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Despite Obamacare Rules, Some Contraceptives May Still Require Co-Pay

| February 11, 2015

Not necessarily fully covered. (Annabelle Shemer)

Not necessarily fully covered. (Annabelle Shemer)

It’s been more than two years since most health plans have been required to cover all Food and Drug Administration-approved methods of contraception without requiring women to pay anything out-of-pocket. But even though an unplanned pregnancy would cost an insurer a lot more than the contraceptives to prevent it, some insurers still try to limit what they cover.


In a recent twist, a reader wrote to Kaiser Health News saying that her daughter’s insurer had moved her generic birth control pill out of the zero copayment tier of her plan’s formulary into a higher tier that requires cost sharing of $19 per month.

That’s not surprising, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. Regulations that allow insurers to use “reasonable medical management techniques” to control costs open the door to excluding some generic pills from free coverage, Sonfield says.

The regulations allow a plan to charge for a brand-name contraceptive, for example, if an equivalent generic is available without charge.

But it doesn’t follow that a plan can charge for most generics as long as it offers some for free, Sonfield says.

“All generics aren’t the same,” he says. “All of the different formulations should be on the zero tier, but that isn’t clear in the current guidelines.”

The health law’s contraceptive coverage requirements are aimed at improving preventive care for women. Most health plans have to comply. Plans with grandfathered status under the law are exempt as are those covering employees of religious institutions and certain privately held companies whose owners have a religious objection to covering contraception for their employees.

This isn’t the only instance in which insurers have tried to sidestep the law’s contraceptive coverage requirements. Some insurers have refused to cover the contraceptive patch or vaginal ring, claiming that those methods use the same hormones as birth control pills. Administration officials said they were separate types of hormonal methods and grouping them together isn’t permitted.

–Michelle Andrews, Kaiser Health News

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7 Responses for “Despite Obamacare Rules, Some Contraceptives May Still Require Co-Pay”

  1. steve miller says:

    so big deal…pay the $19.00 a month and/or don’t have recreational sex!
    Why should the government have to pay for your birth control to begin with?

    • Obama 2015 says:

      The government isn’t paying for ANYTHING. I am when I pay my premiums each month. These companies are breaking the law and you want me to pay an extra $19.00 a month on top of the $65 I pay currently.

  2. Lin says:

    The regulations allow the charge for brand name if genetic equivalent is available for free
    Kinda negates the whole reason for this article

  3. Lin says:

    $65 a month? Soooo lucky
    Who is paying the rest?
    Why wouldn’t you pay for your own drug?
    Who should pay, me?
    You are correct about one thing
    The “government” pays for nothing
    The taxpayers pay

    • Obama 2015 says:

      How can you defend a company breaking the law?

      I have a policy that I purchased though my employer that is taken from my paycheck each month. I am very lucky to have this policy but it is a perk of my employment. Along with my pension and my 401k.

      But it shouldn’t matter if I pay for it via a company or with the new exchanges, The law states my insurance company should cover contraceptives as part of my policy.

      What if the shoe was on the other foot and you had to pay an extra $375.00 a month to get a drug to keep your cancer in remission but by law your policy and the healthcare law states your provider should be paying it but they refuse.

      Are you going to just pay the $4500 a year and take it?

      I think I know the answer.

  4. Anonymous says:

    I love when I hear older people on Medicare grouse about how Obamacare is hurting them (it isn’t ) and why should they pay for someone else’s “recreational sex?” Pretty funny when you consider that The Villages is now known as the “Herpes” capital for the Florida Geritol generation. Why should younger working taxpayers be paying for benefits YOU may be receiving for the Valtrex used to treat THOSE folks (and the problems caused by their “recreational sex”)…or the cholestoral medication you may need to take for your high-fat, high-salt diet.?..or any of the many other meds that older people take in much greater numbers, not only due to the natural process of aging, but also due to the bad health habits older Americans continue to indulge in, despite the many Doctor’s visits they make? Remember, when you point the finger at other people, take care to remember that three are pointing back at you. And other people may not wish to keep paying the full freight for YOUR picadellos either.

    • Obama 2015 says:

      I agree. We should push Medicare to not cover any viagra and Valtrex type medication. They should be paid out of pocket because of their bad decisions.

      I don’t want my tax dollars to go to the sexual health of people that can’t produce children anymore.

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