Does Insurance Cover Iud Birth Control – When the Affordable Care Act was passed ten years ago, many women were happy: The law required most insurers to cover birth control entirely without out-of-pocket costs. But ten years later, the promise of free contraception is out of reach for many.

The reason is buried in the lowercase letters. The law requires insurers to cover each of the 18 Food and Drug Administration-approved birth control methods, such as the pill, intrauterine devices (IUDs), the patch and the ring, at no additional cost. If patients have a medical reason that requires contraception.

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When your plan is fully covered, insurers must provide a “directed exclusion process” that allows the patient to cover contraception. In principle, almost anyone with private insurance should have easy access to whatever form of birth control they and their provider decide is best for them. But in reality, insurers refuse to cover new contraceptives at all, claiming they cover older versions in the same category. Patients who want or need open-label contraceptives face a lengthy and burdensome pre-authorization process and are often denied coverage or face unexpected costs. .

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At the heart of the issue is a battle between two incredibly powerful industrial forces: Big Pharma Vs. Big insurance – the tension between. Drugmakers say insurers are stifling innovation by refusing to cover new products. Insurers, meanwhile, say they offer enough contraceptives to fully comply with the ACA and that insurance plans are unaffordable without coverage restrictions or federal measures to control drug prices. shall be. Meanwhile, patient advocates say ordinary Americans are caught in the middle, unable to access the free contraceptives guaranteed by law.

Supported the Democrats in Congress. They are urging the Biden administration to provide specific guidance on the exemptions process and the level of penalties for non-compliant insurers, particularly in the United States, which could soon change if the Supreme Court rules. This spring ends the nation’s right to abortion.

“People who can’t afford birth control either go without it or use a method that doesn’t meet their needs,” says Mara Gendel Powers, MD, director of Birth Control. And reproductive counselors say. Rights and Health at the National Women’s Law Center. “And that’s not the purpose of this law. It’s … to help people avoid pregnancy when they don’t want to get pregnant.”

Last fall, a group of Democratic House committee chairmen followed by Senators Patty Murray and Ron Wyden sent letters to the Department of Health and Human Services (HHS), the Department of Labor and the Department of the Treasury. In January, all three agencies responded with FAQs reminding insurers of the ACA rules and warning that the agencies are “actively investigating” complaints and may take enforcement action. Then, in February, a group of 34 Democratic senators sent another letter urging the agencies to develop guidelines for the practice of contraceptive exemptions. Last month, another group of more than 100 House Democrats sent another letter urging more enforcement action and asking agencies to help educate the public about the need for the ACA.

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Patient advocates say that while they welcome the agencies’ letter writing and FAQs, it’s not enough: It’s clear that women across the country are still being charged for birth control. are or are being denied birth control altogether. Gandal-Powers said the National Women’s Law Center operates a hotline where people can get help with coverage denials and still see reports.

Advocates say that in many cases, patients prefer one type of birth control over another because they have fewer side effects, are safer or are more effective. About 45 percent of pregnancies in the United States are unintended, and providers point out that contraceptives can be successful in preventing pregnancy if people can take them correctly and tolerate any side effects. “Finding a contraceptive that meets your needs is very important. If you don’t, you won’t get it,” says Beth Battaglino, an obstetrical nurse practitioner and patient advocate. says the CEO of the group HealthyWomen.

Millions of women may be affected, but the extent of the problem is unknown. A Kaiser Family Foundation report last year found that 21 percent of women with private insurance still pay for contraceptives, and researchers say the failures can have a significant impact on patients. Reports compiled by the National Women’s Law Center show that in some cases, patients who could only use a certain type of birth control for medical reasons found that their plan offered it at a cost. Did not comply and did not provide a clear opt-out process. Patients may have to pay hundreds or thousands of dollars out of pocket. Other complaints alleged that women were charged thousands of dollars for services required to administer contraceptives.

Additional patient reports are shared separately with pharmacy benefit managers, requiring patients to complete a process called step therapy, in which patients take other medications before the insurer covers the requested drug. tries A letter reviewed by CVS Caremark told patients to try three other types of birth control before getting the one they want. Another letter from Express Scripts states that a patient will receive coverage only after trying at least five different contraceptives without success.

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Advocates point out that not only is this consumerism and unhealthy, but many women in the country are now at greater risk of unwanted pregnancies. The Supreme Court is expected to rewrite abortion rights this term, and conservative states have limited abortion access to court rulings.

The executive will appear before the US Supreme Court on January 22, 2022 on the abortion issue. Lee Vogel – Act for Abortion/Getty Images

Murray, chairman of the Senate Health, Education, Labor and Pensions Committee, said he was “extremely vigilant” as states tried to limit access to reproductive health. “It’s 2022 when women in this country are asking, ‘Can I get the birth control I need?’ Can I decide when, where and how I want to get married?” Murray said. He added that insurers must comply with the ACA “from day one” and that he expects federal agencies to follow suit soon. will take action. The next step is to issue comprehensive guidelines and then enforce them strongly. Insurers are similarly subject to this law.”

Both HHS and DOL said they are actively investigating the complaints. It can take six to 12 months to become covered by the Centers for Medicare and Medicaid Services (CMS), according to an agency spokeswoman. “CMS takes complaints about contraception coverage seriously and is committed to strong enforcement to ensure that insurers and plans comply with the law,” a spokeswoman said.

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As federal investigations into insurers’ decisions continue, lawyers and drug companies say the future of new birth control products may be up in the air. “If we don’t see coverage of these new products, I fear that will affect the way companies think about contraceptive technology and development over the next ten to 15 years,” says Gandal-Powers.

Some studies show that when insurance coverage for drugs or vaccines is increased, it can lead to greater investment in new products. An NBER working paper published in 2020 drew a similar conclusion: When pharmacy benefit managers, who oversee prescription drug coverage for insurers, excluded newly approved drugs from coverage in 2012 started to do so, investment in new drugs declined relatively. The risk of discharge is high.

Leila Agha, assistant professor of economics at Dartmouth College and lead author of the paper, said this behavior has economic implications. “Investments in research and development of new drugs depend on how profitable those drugs are expected to be. And the profitability of a new drug depends on how many consumers buy it at what price.” can expect,” he says. “So if you make a drug more expensive by moving it to a less favorable or less generous tier of your prescription drug plan, or by removing it from your prescription drug coverage entirely, the cost of that drug will decrease. It is reasonable to expect.” Expectations can influence innovation.

The decision by insurers to exclude certain contraceptives puts manufacturers in trouble. Agile Therapeutics, maker of Twirla, a new low-dose contraceptive patch, acknowledged financial difficulties in its fourth quarter.

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