Barriers to Birth Control: An Analysis of Contraceptive Coverage and Costs for Patients with Private Insurance

"The Affordable Care Act (ACA), signed into law by President Obama in 2010, protects Americans’ access to affordable birth control. The ACA requires private health plans and issuers of health insurance to cover the full range of birth control methods approved by the Food and Drug Administration (FDA), without patient cost-sharing.

In May 2022, following reports that patients were facing barriers to accessing birthcontrol without cost-sharing, Oversight Committee Chairwoman Carolyn B. Maloney opened an investigation into contraceptive coverage for individuals enrolled in private health plans. The Committee sought information from five of the nation’s largest health insurers and four of the largest pharmacy benefit managers (PBMs) to assess how companies are providing patients with access to FDA-approved birth control—without cost-sharing—as required by the ACA. 1

As part of this investigation, the Committee reviewed cost-sharing requirements and coverage exclusions for 120 contraceptive products across approximately 68 health plans and formularies and analyzed each company’s process for approving or denying exceptions to costsharing requirements and coverage exclusions.

The Committee’s investigation identified more than 30 birth control products for which most health insurers and PBMs reviewed impose cost-sharing requirements or coverage exclusions. The investigation found that the processes established for patients seeking exceptions to cost-sharing and coverage restrictions can be burdensome for patients and providers, and that companies deny exception requests on average four or more times out of ten. These practices raise barriers to accessing zero-cost birth control, contrary to Congress’s goal in the ACA.

In the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturning the constitutional right to abortion, access to contraception has become even more important for the 64 million women of reproductive age in the United States. 2 The Biden Administration has recently taken steps to further clarify health insurers’ obligations to provide access to contraception without cost-sharing. It is critical that the federal government build on this progress to ensure Americans have meaningful, equitable access to the full range of FDA-approved contraceptive methods—without facing financial or procedural barriers.."
Contraceptive Coverage and Costs