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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 contraceptives, including OTC contraceptives, would not be a prudent course of action," she said. "OTC contraceptives are typically purchased on-demand rather than through prescription channels that involve physicians, pharmacists, and health plans as payers."

On another point of clarification, the HHS rules allow for some prudent restrictions on access to expensive brand-name contraceptives, according to AMCP.

The HHS guidance indicates "…nothing prevents a plan or issuer from using reasonable medical management techniques to determine the frequency, method, treatment, or setting for an item or service…to the extent not specified in the recommendation or guideline."

Rosato said, "The Academy is pleased that health plans may use appropriate medical management, including formulary decision-making processes, to determine the most appropriate array of oral contraceptive products to be included for coverage. This would allow health plans to select generic contraceptives over more expensive brand name products to fulfill this requirement."

More than 90 oral contraceptive options are currently available, according to the American Congress of Obstetricians and Gynecologists, and many of the brand-name products have generic alternatives. Generics are up to 70 percent less expensive than branded varieties.

"Mandated coverage of branded contraceptives with no copay is unnecessary since many generic contraceptive options are available, and all approved contraceptives are comparably effective," Rosato said. "Effective use of health care resources can minimize overall medical costs, improve patient access to more affordable care and provide an improved quality of life."

To read AMCP's June 13, 2012, comment letter to HHS on this topic, visit www.amcp.org/2012.

About AMCP

The Academy of Managed Care Pharmacy (AMCP) is a national professional association of pharmacists and other health care practitioners who serve society by the application of sound medication management principles and strategies to improve health care for all. The Academy's more than 6,500 members develop and provide a diversified range of clinical, educational and business management services and strategies on behalf of the more than 200 million Americans covered by a managed care pharmacy benefit. AMCP will celebrate its 25th anniversary in 2013. More news and information about AMCP can be obtained on its website, at www.amcp.org.


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SOURCE Academy of Managed Care Pharmacy
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