
Insurers generally do not cowl sure contraceptive strategies without spending a dime, although they’re speculated to cowl most by legislation. Even for long-established strategies, like IUDs, insurers generally make it exhausting for girls to get protection by requiring preapproval.
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Insurers generally do not cowl sure contraceptive strategies without spending a dime, although they’re speculated to cowl most by legislation. Even for long-established strategies, like IUDs, insurers generally make it exhausting for girls to get protection by requiring preapproval.
BSIP/Common Pictures Group through Getty Pictures
For Stephanie Pressure, discovering a contraception methodology that she likes and may get with out paying out of pocket has been a wrestle, regardless of the Reasonably priced Care Act’s promise of free contraceptives for girls and adolescent women in most well being plans.
The 27-year-old doctor recruiter in Roanoke, Va., was completely proud of the NuvaRing, a versatile vaginal ring that ladies insert month-to-month to launch hormones to forestall being pregnant. However her insurer, Anthem, stopped masking the branded product and switched her to a generic model in early 2020. Pressure says the brand new product left her with complications and feeling irritable and short-tempered.
After speaking to her OB-GYN, Pressure tried an IUD. However that made her really feel worse: She had unhealthy cramps, gained 10 kilos and developed extreme hormonal zits. Plus, she was charged $248 for an ultrasound her supplier used to information the insertion of the machine, a cost she efficiently fought.
Pressure additionally thought of a few contraception merchandise accepted in recent times: a non-hormonal vaginal gel known as Phexxi and a vaginal ring known as Annovera that can be utilized for a yr. However Phexxi is not coated by her employer well being plan, and he or she would owe a $45 copayment for Annovera.

Regardless of the Reasonably priced Care Act’s ensures without spending a dime contraception protection, Pressure’s expertise illustrates that even for girls whose well being plans are topic to the legislation’s necessities, acquiring the correct product for gratis may be onerous. New sorts of contraceptives aren’t routinely integrated into the federal checklist of required strategies that insurers use to information protection selections.
As well as, some well being plans proceed to discourage use of even long-established strategies, like IUDs, by requiring suppliers to get approval from the plan earlier than prescribing them.
Client advocates who’ve studied the problem say a course of is spelled out in federal guidelines for girls to get the contraceptives they want, however far too few individuals know that is an possibility. (For extra on how to do that, see the ultimate part under.)
Finally, Pressure went again to the generic model of the NuvaRing, regardless of the unwanted side effects she continues to expertise. She’d desire to be on the branded NuvaRing, which did not give her issues, and the ping-ponging from methodology to methodology has left her exhausted and livid.
“I can’t consider what hoops I’ve needed to leap via between September 2020 and June 2021,” Pressure says, “between switching from the generic NuvaRing to the IUD after which again, combating my insurance coverage and OB-GYN’s workplace on the ultrasound cost.”
In a press release, Anthem says, “Anthem well being plans cowl 222 contraceptive merchandise at $0 value share on our ACA Preventive Listing.” The corporate went on to say that it covers “a minimum of one product” in every of 18 classes of contraception strategies accepted by the FDA.
A coverage meant to chop contraceptives’ prices
Contraception is a really private alternative, and what meets one lady’s wants could not meet one other’s. If avoiding being pregnant is a girl’s prime precedence, a nearly fail-safe methodology like an IUD would be the proper resolution. However for somebody who’s contemplating getting pregnant quickly, a readily reversible methodology like a contraception tablet is likely to be the best choice. Unwanted side effects are essential to think about as effectively, since ladies reply in another way to the hormones in numerous contraception merchandise.
Earlier than the Reasonably priced Care Act (ACA) required no-cost contraception protection, researchers estimate that as much as 44% of girls’s out-of-pocket well being care spending went towards contraceptives. The ACA requires most industrial well being plans to cowl a complete checklist of Meals and Drug Administration-approved strategies with out charging ladies something.
Church plans and non secular nonprofits, in addition to employers and faculties that object to contraception, are exempt from the protection necessities. Plans that had been grandfathered beneath the legislation are additionally exempt. Uninsured ladies do not profit from the mandate both.
However the federal guidelines don’t require well being plans to cowl each single contraceptive. After the ACA handed in 2010, the federal Well being Assets & Companies Administration (HRSA) developed tips for girls’s preventive providers.
These tips say ladies ought to have entry with out value sharing to a listing that covers the 18 FDA-approved strategies, together with oral contraceptives, vaginal rings, cervical caps, IUDs, implantable rods and sterilization. Below federal guidelines, well being plans should cowl a minimum of one product in every class.
New merchandise are not noted
Neither the HRSA tips nor a contraception chart revealed by the FDA addresses newer strategies, together with Phexxi, a gel that regulates vaginal acidity to cut back the chances a sperm reaches an egg. It was accepted by the FDA final yr.
Nor do they incorporate fertility-awareness cell phone apps the FDA accepted in recent times akin to Pure Cycles, which tracks a girl’s temperature and menstrual cycle to keep away from being pregnant.
“There’s an actual want for brand spanking new steerage that retains up with new strategies,” says Mara Gandal-Powers, director of contraception entry on the Nationwide Girls’s Legislation Heart.
Many insurers have balked at masking Phexxi, says Rameshwari Gupta, director of strategic markets for Evofem Biosciences, which markets Phexxi. A field of 12 single-use applicators — customers use one earlier than having intercourse — prices $267.50 with out insurance coverage, she says.
“After I began speaking to payers, all of them stated, ‘The place are you on this FDA chart?’ ” she says.
In response to an FDA spokesperson, the contraception chart is for client training functions solely and “was not created with the intent of driving protection selections.” The company is within the technique of updating it.
In a press release, the HRSA says it’s reviewing the proof on contraceptives and expects to finish its evaluation late this yr. If it opts to make revisions, it’s going to publish draft suggestions to replace the ladies’s preventive providers tips. These shall be finalized after a public remark interval and develop into efficient a yr later.
At this level, well being plans contemplate Phexxi to be a spermicide and are required to cowl just one sort of spermicide with out value sharing, says Kristine Develop, a senior vice chairman at AHIP, a medical insurance commerce group.
“If Phexxi is certainly thought of a brand new methodology of contraception, each the FDA and HRSA would want to make this clear,” she added.
Price sharing and preapprovals restrict entry to some strategies
The vaginal ring Annovera, accepted by the FDA in 2018, is usually coated by well being plans, in response to Develop, although it will not be out there with out value sharing. The typical retail value is $2,457 a yr, in response to GoodRx.
A technique plans have made it tough for girls to entry sure contraceptives, even these on the checklist of accepted medication, is by requiring that their suppliers get approval from the insurer first, typically by offering documentation that the product is medically needed.
Below UnitedHealthcare’s protection coverage for Phexxi, for instance, earlier than protection shall be approved, members should have documented causes that they’re unable to make use of eight different contraceptive strategies, together with oral contraceptives, the contraceptive patch, a vaginal ring, injections and spermicides. Suppliers additionally should attest that they’ve recommended sufferers that Phexxi is much less efficient at stopping being pregnant than another strategies.
In a press release, UnitedHealthcare says it covers “a broad array” of generic and brand-name choices, and it follows scientific proof to develop its checklist.
But customers have a technique to get the precise drug that’s most applicable for them, in response to a report by the Nationwide Girls’s Legislation Heart.
Methods to get a contraception methodology coated
Below federal guidelines, if a physician or different well being care supplier determines {that a} affected person wants a selected contraceptive, even when it is not on the checklist of accepted merchandise for the affected person’s plan, the insurer is required to have an expedient course of for the affected person to hunt a waiver.
“It is less than the insurance coverage firm whether or not to cowl that methodology — it is as much as the supplier,” says Adam Sonfield, government editor for coverage evaluation on the Guttmacher Institute, a analysis and advocacy group centered on ladies’s reproductive well being.
However in response to the Nationwide Girls’s Legislation Heart report, many insurers, sufferers and their suppliers aren’t conscious of the requirement, and state companies do not implement these so-called exceptions insurance policies.
If sufferers run into bother getting the strategy they need, “we usually advocate submitting an attraction with their insurance coverage supplier,” says Gretchen Borchelt, vice chairman for reproductive rights and well being on the Nationwide Girls’s Legislation Heart.
Stephanie Pressure says she was unaware of any course of she might have used to get the NuvaRing coated with out value sharing. Neither her well being care supplier nor the insurer talked about the chance.
She lately had an appointment with a brand new supplier who she hopes shall be a greater advocate for her.
KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points.