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Academy of Managed Care Pharmacy (AMCP) Helps Explain Health Care Law's Contraception Coverage Provision
Date:8/13/2012

ALEXANDRIA, Va., Aug. 13, 2012 /PRNewswire-USNewswire/ -- Millions of Americans are now able to obtain their birth control products at no out-of-pocket costs under a provision in the Affordable Care Act (ACA) that requires employers and insurers to offer contraceptive coverage and certain other preventive health services with no patient copayment, coinsurance or deductible. Government rules, however, may allow for some restrictions on which birth control products can be obtained, including condoms and brand name contraceptives, according to the Academy of Managed Care Pharmacy (AMCP).

The contraceptive-coverage provision, which started Aug. 1, will take effect for individual policy holders as their health benefits renew over the next 12 months.

The Academy, meanwhile, has asked for guidance from the Department of Health and Human Services (HHS) to further clarify the provision as it relates to over-the-counter (OTC) contraceptives.

According to HHS's March 21, 2012, interim guidelines, coverage is required without patient cost sharing, for "all Food and Drug Administration (FDA) approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity," as prescribed by a provider.

A footnote in the HHS guidelines, however, indicates: "this excludes items and services such as vasectomies and condoms."

Although the footnote provides some guidance on the issue, the Academy has asked HHS to further clarify the regulations to state that health plans be mandated only to cover products that require a prescription by a duly licensed health care provider. AMCP also has asked HHS to clearly state in the regulations themselves that coverage of OTC products is not mandated, rather than simply mention these exclusions in a footnote.

The Academy supports this exclusion, said AMCP Chief Executive Officer Edith A. Rosato, RPh, IOM. "Coverage of all FDA-approved
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SOURCE Academy of Managed Care Pharmacy
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