May 18, 2024 - Washington, D.C. - On Thursday, Rep. Jamie Raskin, Ranking Member of the Committee on Oversight and Accountability, sent letters to the five of the largest health insurers and four of the largest pharmacy benefit managers (PBMs), requesting information on how the companies plan to respond to revised federal guidance designed to improve no-cost access to birth control for millions of women across the country and urging the companies to implement this guidance. 

“Adopting the Tri-Departments’ recommended approach on coverage of contraception is vital to ensuring that millions of women of reproductive age have increased access to no-cost contraception—something that is particularly important as Republicans continue to enact stringent bans on abortion across the country.  I urge you to expeditiously enact the recommended approach, as well as respond to our request for information,” wrote Ranking Member Raskin.

In October 2022, Oversight Democrats issued a report examining the financial barriers that patients may face from health insurers and PBMs when trying to access medically-appropriate contraceptive products.  Under the Affordable Care Act (ACA) and related guidance, contraceptive products that a patient’s health care provider deems medically appropriate should be made available to that patient at no-cost.  However, the report found that many patients covered by five of the largest health insurers and four of the largest PBMs do not have access to free birth control under the law. To reduce financial barriers for patients trying to access birth control products, Oversight Democrats recommended in part that the three Departments that regulate contraceptive coverage (Health and Human Services, Treasury, and Labor) revise federal guidance to make sure that more medications are covered at no-cost on patients’ insurance plans.

Specifically, Oversight Democrats recommended that the Tri-Departments;

• Clarify requirements regarding appropriate medical management for coverage of contraceptives.  The Tri-Departments could issue guidance clarifying that all Food and Drug Administration-approved contraceptive products that do not have a therapeutic equivalent should be covered without cost-sharing as part of every plan or formulary—allowing health plans and PBMs to use medical management techniques to prioritize the use of generic pharmaceuticals where possible, while ensuring that patients have access without cost-sharing to products that do not yet have a generic version.

In December 2023, Oversight Democrats released a staff analysis finding that as many as 49 million women of reproductive age could potentially benefit from revised federal guidance adopting this recommendation. This includes women in states that have already implemented similar guidance at the state level whose insurance coverage is not subject to those laws, as well as women in states that have not yet implemented similar guidance at the state level.  

In January 2024, the Tri-Departments issued guidance recommending that companies adopt the approach recommended by Oversight Democrats.  Today’s letters request information from the companies that Oversight Democrats investigated in the 117th Congress on how and by what date those companies plan to implement this recommendation and ensure that all women have access at no cost to the contraception recommended by their health care providers. 

Click here to read the letter to Aetna.

Click here to read the letter to Cigna.

Click here to read the letter to Elevance Health.

Click here to read the letter to Humana.

Click here to read the letter to United Healthcare.

Click here to read the letter to CVS Caremark.

Click hereto read the letter to Express Scripts.

Click hereto read the letter to Optum Rx.

Click here to read the letter to Prime Therapeutics.
Source: Committee on Oversight and Accountability: Democrats