Congresswoman Suzan DelBene (D-Wash) expressed concerns over inaccurate information regarding the coverage and cost of contraceptive services in a letter to insurance carriers with plans on the Washington State Health Care Exchange. The letter urges insurers to take action to address reports that insurers are failing to provide accurate information in response to enrollees’ questions about birth-control coverage.
Under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), insurers selling Qualified Health Plans (QHPs) are required to provide no-cost access to all FDA-approved forms of birth control. However, according to a recent report, some women who inquired with insurers were improperly told they’d have to pay a copay to access birth control. DelBene wrote her letter to insurers to protect QHP enrollees from further misinformation.
DelBene’s letter cautions that while ACA provisions are intended to guarantee access to FDA approved “oral contraceptives, the ring, the patch, the shot, implants, intrauterine devices (IUDs), emergency contraception, and subdermal implants,” those reforms only have their intended effect if women have access to accurate coverage information about those benefits.
The letter focused on the findings of a Northwest Health Law Advocates and NARAL Pro-Choice Washington survey, which discovered that insurance company “representatives routinely told callers that certain forms of contraception are available at no cost but that others are only available with cost-sharing, and no single carrier consistently told callers that all FDA-approved methods are available without cost-sharing—the precise level of coverage required by the ACA.” According to the survey, certain contraceptive methods are also “frequently left off carriers’ formularies or listed in formulary tiers that require cost-sharing.”
To address the problem, DelBene’s letter includes several questions that she would like insurers to ask themselves about their contraception coverage. The questions inquire as to whether insurers have all FDA-approved contraceptive methods adequately listed in their formularies and available without cost-sharing. The questions ask about access to the formulary and whether insurers make their formularies available online. Additionally, the letter asks whether insurers plan to train customer service and sales representatives on the contraceptives that plans cover. Finally, the letter asks how insurers plan to make branded or non-preferred contraceptive services available at no cost to plan enrollees when generics are unavailable.