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 

Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions

"The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) has numerous provisions affecting private health insurance and public health coverage programs. Many of these provisions take effect in 2014. This report provides resources to help congressional staff respond to constituents’ frequently asked questions (FAQs) about the law. The report lists selected

resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize ACA’s provisions..."

Affordable Care Act

Affordable Health Care: Speaking to Women's Unique Health Needs

Find information on how the Affordable Health Care law address the unique health care concerns of women.
Affordable Health and Women's Needs
http://www.hhs.gov/healthcare/facts/blog/2013/08/womens-health-needs.html

Individual Mandate and Related Information Requirements under ACA

"This report describes the individual mandate under Section 1501 and Section 10106 of the Patient
Protection and Affordable Care Act (ACA, P.L. 111-148), as amended by Section 1002 of the
Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). Hereinafter, ““ACA”” will
refer to ACA as amended by the reconciliation act and other laws. In addition, ACA includes
several reporting requirements designed, in part, to assist individuals in providing evidence of
having met the mandate, as well as other related information about their health insurance. These
requirements are also described in this report..."

The Health Care Law & You

"The Affordable Care Act puts in place strong consumer protections, provides new coverage options and gives you the tools you need to make informed choices about your health. In this section, learn about how the law affects you..."

Affordable Care Act and Preventive Services

"The Affordable Care Act was passed by Congress and signed into law by President Obama on March 23, 2010. Many insurance plans are now required to cover the full cost of important preventive services, like medical tests (screenings) and shots (vaccines)..."

Affordable Care Act Rules on Expanding Access to Preventive Services for Women
"...The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without cost sharing.

Under the Affordable Care Act, women’s preventive health care services – such as mammograms, screenings for cervical cancer, and other services – are already covered with no cost sharing for new health plans. The Affordable Care Act also made recommended preventive services free for people on Medicare. However, the law recognizes and HHS understands the need to take into account the unique health needs of women throughout their lifespan.

On August 1, 2011, the Department of Health and Human Services (HHS) adopted additional Guidelines for Women’s Preventive Services – including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening – that will be covered without cost sharing in new health plans starting in August 2012. The guidelines were recommended by the independent Institute of Medicine (IOM) and based on scientific evidence..."
view full guidelines