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Study: Some Insurers Duck Obamacare Contraception Mandate

By Melanie Zanona, CQ Roll Call

April 16, 2015 -- Some private insurers are ducking the health care overhaul's requirement that they provide a wide range of birth control options to women at no cost, according to the nonprofit Kaiser Family Foundation.

Although a recent study found many health plans are observing the spirit of the contraceptive mandate in the law, some are declining coverage or requiring cost-sharing for certain methods. Under the law, Food and Drug Administration–approved forms of birth control that are prescribed by a health care provider generally must be provided to women without a copayment.

FDA lists five different categories as approved types of contraceptive products: barrier methods, hormonal methods, emergency contraception, implanted devices, and permanent methods.

The study examined 20 different insurers in five different states and found vaginal rings were the least likely method to be covered. Five plans required cost-sharing for the NuvaRing, while one did not cover it all and three required step-therapy or prior authorization. Some plans placed limitations on coverage of implants and the patch. Most of the insurers covered at least one type of long-acting intrauterine device, but varied slightly by brand.

"There are still some women who are not fully benefiting from this huge advance in women's health," said Gretchen Borchelt, vice president for health and reproductive rights at the National Women's Law Center, at a briefing on the report. "I don't think these are just barriers [to contraception,] these are violations of the law."

Insurers are permitted to use "reasonable medical management" to determine coverage limitations of any preventive services. But the term was not explicitly defined by law, which has caused variations among plans.

"There are some exceptions that appear to be attributable to the carriers' interpretations of the HHS regulations," the report stated. "In particular, some of the plans did not differentiate between similar hormonal formulations that had different delivery mechanisms."

When it comes to emergency contraception, most insurers covered Plan B or its generic equivalent, but over half did not also cover the ella EC pill, which has a longer window of effectiveness. Recent reports suggest that women with higher BMIs might have better success rates with ella.

If a woman has a medical reason to obtain a preventive service not normally covered by their plan, the Department of Labor said insurers can provide it with no-cost sharing through a "waiver process." However, the study did not find a single plan that had established a formal process.

"A substantial number of plans were reluctant to be interviewed," said Edward Anselm, consultant medical director for Health Republic Insurance of New Jersey. "It reflects the inherent controversy around contraception."

Another facet of the birth control mandate that is not unfolding as supporters envisioned is the religious accommodation provided by the Health and Human Services Department. The Kaiser study found that "few, if any" religious organizations with objections to contraceptives have requested a workaround, which has been the subject of recent legal scrutiny and debate in Congress.

Insurers can provide no-cost birth control for workers of nonprofit religious hospitals, universities, and other groups that ask for exemptions.

But religious organizations were unsatisfied with the accommodation, arguing that it still forces them to facilitate their employees' access to contraception, and several have filed lawsuits that are still pending in lower courts across the country.

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