Oversight Democrats Release New Staff Analysis Showing 49 Million Women Could Have Access to No-Cost Contraceptive Care

Washington, D.C. (December 8, 2023)—Today, Rep. Jamie Raskin, Ranking Member of the Committee on Oversight and Accountability, released a new staff analysis that shows up to 49 million more women could have access to no-cost contraception as intended under the Affordable Care Act (ACA) if the Departments of the Treasury, Labor, and Health and Human Services revise existing guidance to ensure that more medications are covered at no-cost on patients' insurance plans.

"A key determinant in the economic and emotional well-being of women is control over their own reproductive health. As Republicans fight for a nationwide criminal abortion ban, the Biden-Harris Administration has taken bold steps to guarantee women's access to contraception. The Administration can build on its success to break down remaining financial barriers for women seeking access to the reproductive care they need. That's why I'm urging the Departments of Treasury, Labor, and Health and Human Services to issue additional guidance to ensure millions more women can access the birth control products they need for their health and the security of their families," said Ranking Member Raskin.

In October 2022, Oversight Democrats issued a report examining the financial barriers that patients may face from health insurers and pharmacy benefit managers (PBMs) when trying to access medically-appropriate contraceptive products. Under the ACA and related guidance, contraceptive products that a patient's health care provider deems medically appropriate should be made available to that patient at no-cost. However, the report found that many patients do not have access to free birth control under the law. To reduce financial barriers for patients trying to access birth control products, Oversight Democrats recommended in part that the three Departments that regulate contraceptive coverage (Health and Human Services, Treasury, and Labor) revise federal guidance to make sure that more medications are covered at no-cost on patients' insurance plans.

Oversight Democrats have made two recommendations to ensure that 49 million women—in all states and on all health plans—would have the same financial protections when accessing no-cost contraception:

• Clarify requirements regarding appropriate medical management for coverage of contraceptives. The Tri-Departments could issue guidance clarifying that all FDA-approved contraceptive products that do not have a therapeutic equivalent should be covered without cost-sharing as part of every plan or formulary—allowing health plans and PBMs to use medical management techniques to prioritize the use of generic pharmaceuticals where possible, while ensuring that patients have access without cost-sharing to products that do not yet have a generic version.

• Encourage exceptions processes that are automatic at the point of prescribing. To ensure the exceptions process is "easily accessible, transparent, and sufficiently expedient," this process could be automatic at the point of prescribing, so that patients and their providers would not have to take any additional steps to ensure patients have access to medically appropriate contraceptive products without cost-sharing. The exceptions process would remain important even if all contraceptive products without a therapeutic equivalent are covered without cost-sharing, because some patients will be unable to use the therapeutic equivalent to a branded product—for example, some patients may be allergic to the color, flavoring, or preservatives used.

Analyzing census data, insurance coverage, and state laws regarding contraceptive coverage, Democratic Staff found that 49 million women could potentially benefit from the implementation of this guidance. This includes women in states that have already implemented similar guidance at the state level whose insurance coverage is not subject to those laws, as well as women in states that have not yet implemented similar guidance at the state level.

Click here to read the staff analysis.

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