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Payers Told to Cover All FDA-Approved Birth Control Methods, Given Guidance on BRCA Testing


The guidance comes after advocacy groups and members of Congress complained of widespread violations of the Affordable Care Act's requirement that all forms of birth control be covered without a co-payment, not just the low-cost methods. The action also responds to recent reports that payers have balked at requests for BRCA testing even when indicated.

The Obama Administration yesterday told insurers they must cover at least one form of birth control in each of the 18 methods approved by the FDA, following reports that many plans were not following the Affordable Care Act (ACA) mandate to make birth control free.

The guidance, which came in the form of a “Frequently Asked Questions” memo from the Departments of Health and Human Services, Treasury, and Labor, comes after widespread violations of the ACA were uncovered by the National Women’s Law Center, the Kaiser Family Foundation (KFF), and others. The guidance spells out when birth control and genetic testing and counseling services must be covered, and even when health plans must pay for services for transgender persons, if they are recommended by a healthcare provider.

Methods that must be covered go beyond birth control pills and include long-acting methods such as the contraceptive ring and the intrauterine devices, which have higher upfront costs. The guidance also clarified that the ACA requires plans to cover other items related to women’s health, including preconception and prenatal care.

The guidance outlines when insurers must pay for genetic counseling and screening for the BRCA-1 and BRCA-2 genes, which indicate a susceptibility to breast and ovarian cancer. Since the actress Angelina Jolie recently announced her second surgery for removal of her ovaries, following a previous breast removal surgery, there have been published reports suggesting some payers are declining to pay for BRCA testing.

Yesterday’s guidance makes clear that screening should be covered for women “who have family members with breast, ovarian, tubal, or peritoneal cancer,” using 1 of several screening tools designed to identify the risk of a BRCA mutation. Women at risk “should receive genetic counseling, and, if indicated after counseling, BRCA testing.”

Throughout the document, the guidance requires payers to defer to the recommendation of the woman’s healthcare provider. Before yesterday’s guidance, complaints from advocacy groups and even some members of Congress centered on the issue of payers overruling physician recommendations; many health plans only covered low-cost birth control methods without co-payment, despite what the ACA requires.

As a result, some women paid $600 a year or more for birth control despite having insurance, according to Cecile Richards of Planned Parenthood. “This is a victory for women and the more than 30,000 Planned Parenthood supporters who spoke out to ensure that all women, no matter what insurance they have, can access the full range of birth control methods without a co-pay or other barriers,” Richards told NBC News.

Last week, US Senator Patty Murray, D-Washington, sent a letter co-signed by 38 Senate Democrats and called on the Obama Administration to investigate, saying that when women are unfairly charged co-payments for birth control, some will lose access. “Research shows that costs can significantly restrict women’s ability to get the right care.”

Yesterday’s ruling did not address situations covered by the US Supreme Court ruling that affected closely held for-profit companies that object to paying for birth control on religious grounds. However, KFF said in a statement that insurers have reported very few requests for accommodations.

Around the Web

FAQs About Affordable Care Act Implementation

Insurers Must Cover All FDA Approved Birth Control Methods, Administration Says

Senator Patty Murray Urges Stronger Enforcement of Birth Control Coverage

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