Contraceptive Services Must be Provided without Cost-Sharing: HHS Guidance Update

The Biden-Harris administration has announced a series of actions developed to protect and expand access to no-cost contraception, according to the US Department of Health and Human Services (HHS). The guidance has been issued in support of President Joe Biden’s June 23, 2023, Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services.

The new guidance, released on January 22, in conjunction with the Departments of Labor and Treasury, targets group health plans and issuers of group and individual health insurance coverage to “ensure compliance with the Affordable Care Act’s (ACA) requirement to cover contraception without cost-sharing, through strategies including covering all Food and Drug Administration (FDA) approved drugs and drug-led devices…”

Writing to Medicare plans, health insurance issuers, and State Medicaid and CHIP programs to coincide with the HHS announcement, HHS Secretary Xavier Becerra said that the Department will continue to press for removal of “impermissible barriers” to contraceptive coverage. The Administration and US lawmakers have considered taking this week’s action for several months to reign in health insurance actors reportedly ignoring existing obligations under federal law to provide no-cost contraceptive coverage. Barriers brought to the attention of HHS and others include requiring completion of step-therapy protocols, use of “unduly burdensome administrative requirements,” or requiring cost-sharing for specific aspects of a preventive service that itself is covered. 

The joint guidance was released in the standard Centers for Medicare and Medicaid Services (CMS) footnoted and referenced “frequently asked questions” (FAQ) format and is an update to earlier and similar guidance documents. “FAQs about affordable care act and consolidated appropriations Act, 2021 Implementation (Set 64)” answers questions from stakeholders and provides “a new pathway” for plans to comply with requirements of the ACA including covering a broader range of FDA-approved drugs and particular devices at no cost to plan subscribers.

President Biden’s 2023 Executive Order for Secretaries to develop plans that would ensure comprehensive contraceptive care coverage for any contraceptive approved, granted, or cleared by the FDA. This care should be provided without cost-sharing for participants.

“From day 1, the Biden-Harris Administration has made clear that women should have access to the healthcare they need, including contraception and other family planning services,” the Secretary wrote.2

“I’m writing to reaffirm that access to reproductive healthcare is a core priority of the US Department of Health and Human Services (HHS) and to remind all stakeholders of the critical need to comply with existing standards of access to comprehensive, quality contraception—including through Medicaid, Medicare, and under the Affordable Care Act,” Becerra added.

Source: HHS Secretary Xavier Becerra announces new actions to increase contraceptive care coverage on 51st anniversary of Roe v. Wade. US Department of Health and Human Services. January 22, 2024. Accessed January 23, 2024. https://www.hhs.gov/about/news/2024/01/22/hhs-secretary-xavier-becerra-announces-new-actions-increase-contraceptive-care-coverage-51st-anniversary-roe-v-wade.html