Introduction and Background
Many states have adopted policies requiring public insurance coverage and/or state-regulated private health insurance coverage of an extended supply of certain hormonal contraceptives methods (e.g., the pill, patch, ring, self-administered injection) dispensed at one time for up to a 12-month supply. Policies requiring insurers to cover an extended supply of contraceptives are one of many strategies states may use to increase access to contraceptive care.
Federal regulations require public health insurance and most private health insurance to cover at least one form of each contraceptive method that is approved by the Food and Drug Administration (FDA) with no patient cost-sharing. Federal requirements do not specify the quantity or supply of contraceptives that must be covered without cost-sharing, and insurance may cover contraceptive methods for different intervals (for example, a three-month supply of birth control pills). Health insurance typically covers a one-to-three-month supply of hormonal contraceptives at one time, noting considerations that include patient safety, medical waste, and cost containment. A one-year supply of self-administered hormonal contraceptives, however, may alleviate common barriers associated with access and improve medication adherence.
How can extended supply policies improve access to contraceptives?
One-third of women in the U.S. who have tried to obtain a contraceptives prescription report one or more barriers to access. Work schedules, transportation, child care, and privacy concerns can create barriers for individuals who must make frequent trips to a pharmacy to refill a prescription.
contraceptives use may also be interrupted because of medical barriers, including expired or lapsed prescriptions, lack of access to a prescribing provider, or required medical screenings (e.g., pap smear test, testing for sexually transmitted diseases) prior to receipt of a prescription. Hormonal contraceptive methods are administered on a daily or monthly basis and require consistent use to be effective.
By requiring public and/or private health insurance to cover the cost of a longer supply of contraceptives dispensed at one time, state-extended supply policies may be able to alleviate some of the common barriers that limit or interrupt an individual’s access to their preferred contraceptive method.
Key Considerations for State-Extended Supply Policies
State-extended supply polices are complex, and states must consider which types of health insurance plans could be required to cover extended supplies of contraceptives, what types of contraceptive methods will be covered, intervals of contraceptives covered, and covered refills.
Types of Health Insurance that Could Cover an Extended Supply
States policies that require insurance coverage of an extended supply of contraceptives may apply to public insurance (e.g., Medicaid, Children’s Health Insurance Plans), state-regulated private health insurance, or both. For example:
Louisiana requires Medicaid managed care organizations (MCOs) to cover a six-month supply of an FDA-approved contraceptive method prescribed by a licensed provider for Medicaid beneficiaries who have used the same contraceptive method for the six months prior.
Connecticut requires most individual and group health insurance plans to cover a 12-month supply of an FDA-approved contraceptive drug, device, or product prescribed by a licensed provider. No insured member shall be entitled to receive a 12-month supply of a contraceptive drug, device, or product pursuant to this subdivision more than once during any policy year.
Washington, DC, requires individual and group health insurance plans, health insurance plans offering coverage for prescription drugs, and Medicaid to cover a 12-month supply of contraceptives dispensed at one time.
Covered Contraceptive Methods and Prescribing Reasons
States may require public and/or private insurance coverage for an extended supply of certain methods of self-administered contraceptives, such as the pill, patch, ring, or injections. State-extended supply policies may also specify that coverage of an extended supply of contraceptive methods is required for treatment of health conditions (e.g., endometriosis). For example:
Virginia requires public and private insurance coverage for a 12-month supply of the pill, patch, ring, and self-administered injection with no patient cost-sharing. Health insurance must cover a prescription for reasons in addition to pregnancy prevention, including decreasing the risk of ovarian cancer or managing the symptoms of menopause.
Interval of Contraceptives Covered
State-extended supply laws may require public and/or private insurance coverage for a six-month or 12-month supply of hormonal contraceptives. States may establish initial dispensing requirements for a shorter interval of contraceptives, such as requiring that two or three months of contraceptives are dispensed initially, after which individuals can receive a six- or 12-month supply. For example:
Colorado requires most individual and group private health insurance to cover a three-month supply for the initial dispensing of new contraceptive prescription for oral contraceptives, followed by a 12-month supply for subsequent refills of the same prescription. Coverage of an extended supply of oral contraceptives or the vaginal ring is required regardless of whether the individual was enrolled in their health plan when the initial prescription was filled.
Refill Requirements
State policies may specify how many refills must be covered within a plan year when an extended supply of contraceptives is initially dispensed. Some states may require health plans to cover dispensing a second extended supply within a plan year or within 12 months of the initial dispensing. For example:
Montana requires private health insurance coverage for a 12-month supply of an individual’s preferred hormonal contraceptive method 60 days before an existing prescription expires. Private health insurance is not permitted to require prior authorization, except to review medical necessity for prescribing a brand-name contraceptives instead of generic contraceptives. Also, insurers are not permitted to impose waiting periods to determine coverage of a 12-month supply of prescribed contraceptives.
Acknowledgments
This explainer was written by Dakota Staren. Several NASHP staff contributed to the case study through input, guidance, or draft review, including Anna Lipton Galbraith and Karen VanLandeghem.
This work is made possible through generous support from Arnold Ventures.