Huge: Biden-Harris Admin proposes new rule dramatically expanding coverage of birth control

Currently, the Affordable Care Act's preventative services mandate requires most employer-provided & individual market healthcare policies to provide coverage for the following types of birth control products & services:

Plans in the Health Insurance Marketplace® must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.

Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your  deductible

Covered contraceptive methods

FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

• Barrier methods, like diaphragms and sponges
• Hormonal methods, like birth control pills and vaginal rings
• Implanted devices, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B® and ella®
• Sterilization procedures
• Patient education and counseling

Plans aren’t required to cover drugs to induce abortions and services for male reproductive capacity, like vasectomies.

To be sure if a specific method is covered by your plan, check your plan’s materials or ask your employer or benefits administrator.

Birth control benefits rules for employer-provided coverage

If you work for a religious employer

Health plans sponsored by certain exempt religious employers, like churches and other houses of worship, don’t have to cover contraceptive methods and counseling.

If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket. Contact your employer or benefits administrator for more information.

If you work for a non-profit religious organization

Some non-profit religious organizations — like non-profit religious hospitals and institutions of higher education that certify they have religious objections to contraceptive coverage — don’t have to contract, arrange, pay, or refer for contraceptive coverage.

• If your health plan is sponsored or arranged by this type of organization, an insurer or third party administrator will make separate payments for contraceptive services that you use.
• You’ll have access to contraceptive services without a copayment, coinsurance, or deductible when they are provided by an in-network provider.

Contact your employer or health plan to learn more.

This is all good news (well, except for the religious exemptions in my opinion of course), but the prescription requirement as well as "services for male reproductive capacity" missing from the list are pretty glaring exceptions...until now.

Via the Centers for Medicare & Medicaid Services (CMS):

Today, the Biden-Harris Administration, through the Departments of Health and Human Services, Labor, and of the Treasury (together, the Departments), proposed new rules that would continue building upon the Affordable Care Act (ACA) by expanding coverage of recommended preventive health services.

As part of this proposal by the Centers for Medicare & Medicaid Services (CMS), for the first time, most group health plans and health insurance issuers would be required to cover over-the-counter (OTC) contraceptives without cost sharing or requiring a prescription, a key action taken by the Administration to expand access to and awareness of coverage for birth control and other critical health services. In addition, plans and issuers would have to provide consumers with more choices of covered contraceptives, such as a broader array of contraceptive drugs (for example, a wider selection of covered oral contraceptive pills) and drug-led combination products (for example, a wider selection of covered intrauterine devices (IUDs)).

The proposed rules also further reinforce plans’ and issuers’ responsibility to cover Food and Drug Administration (FDA)-approved, -cleared, and -granted birth control methods without cost sharing. This proposed rule comes in response to reports that many plans and issuers continue to impose barriers to contraceptive coverage, such as requiring patients to satisfy step therapy protocols, imposing unduly burdensome administrative requirements, or requiring cost-sharing for services that are integral to the application of the preventive service provided.

I'm assuming the last of these include bullshit like charging for the needle used to inject the drug and so on.

...The proposed rules would build on previous guidance and require health plans and issuers to provide an easily accessible, transparent, and sufficiently expedient exceptions process for all recommended preventive services. An exceptions process can be crucial for people who face limits on medically necessary care or coverage and would ensure they can access all medically necessary, recommended preventive services, including contraception, as well as certain immunizations, screenings, and other critical services for infants, children, and adolescents.

Since its inception, the ACA has required most group health plans and health insurance issuers to provide coverage for preventive services recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the Health Resources and Services Administration, without any cost-sharing requirements, such as a copayment, coinsurance, or deductible. The proposed rules would strengthen these existing consumer protections by requiring plans and issuers to cover OTC contraception without a prescription and without cost sharing. 

Millions of people continue to face barriers to obtaining preventive services, like contraception, even as access has become more critical. In the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization to overturn Roe v. Wade, these proposed rules represent a direct response to President Biden’s Executive Orders on Protecting Access to Reproductive Healthcare Services and Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services. 

The rules would require plans and issuers to add a disclosure to the results of any online Transparency in Coverage self-service tool search for covered contraceptives that explains OTC contraceptives are covered and include phone and web contacts for additional information regarding contraceptive coverage. These proposed rules would not modify federal conscience protections related to contraceptive coverage for employers, plans, and issuers.

The Departments also released additional guidance addressing plans’ and issuers’ coverage of other recommended preventive services, as required under the ACA. This guidance focuses on coverage of pre-exposure prophylaxis (PrEP), medication that reduces the risk of HIV infection, reiterating the requirement to cover preventive PrEP and related services without cost sharing.

The guidance also responds to continued reports that, in some cases — including where plans and issuers have not provided clear guidance to network providers on how to code preventive services — plans and issuers are denying claims or imposing cost sharing for recommended preventive items and services because of how a provider codes for those services. The guidance released today seeks to clarify how plans and issuers can mitigate challenges with coding and processing of claims for recommended preventive services to ensure that individuals are not improperly charged for important preventive care. In addition to the ACA requirements, the guidance addresses coverage requirements of chest wall reconstruction with aesthetic flat closure, if elected by the patient in connection with a mastectomy, under the Women’s Health and Cancer Rights Act.

There's a lot going on here, but the most obvious is the addition of over the counter contraceptives to what has to be covered at no out of pocket cost to the enrollee.

As for the other major gap in current requirements (male-controlled contraception), it looks like condoms would be included, but I don't see the word "vasectomies" listed in the rule itself, although there is a reference to "removal of the phrase 'female-controlled'" which I presume would mean vasectomies would have to be covered as well (assuming they aren't already...I've heard conflicting guidance on this in spite of HC.gov specifically stating that they aren't currently included).

Either way, this is a Big F*cking Deal, as President Biden would put it.