Yvette D. Clarke

02/22/2024 | Press release | Distributed by Public on 02/22/2024 14:07



February 22, 2024


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Washington, D.C. - Today, Congresswoman Yvette D. Clarke (NY-09) joined Democratic Women's Caucus (DWC) Chair Lois Frankel (FL-22), DWC Policy Co-Chairs Ayanna Pressley (MA-7) and Kathy Manning (NC-6), and Pro-Choice Caucus Contraception & Family Planning Task Force Chair Judy Chu (CA-28), along with Senators Elizabeth Warren (D-MA), Catherine Cortez Masto (D-NV), and Tina Smith (D-MN), and over 150 House and Senate Democratic colleagues in urging health insurers to fully comply with the Affordable Care Act (ACA) contraception coverage requirement. Specifically, the members urged insurers to adopt a "therapeutic equivalence standard" ensuring coverage-without cost sharing-of every FDA-approved birth control product that does not have a therapeutic equivalent (generic). The letter comes after years of systemic noncompliance by insurance plans, forcing women to pay out of pocket or face administrative red tape to access the birth control that works best for them.

"We write to express our concerns that your members are not complying with the Affordable Care Act contraception coverage requirement, and to urge them to consider immediate adoption of the therapeutic equivalence standard outlined by the Departments of Health and Human Services, Labor, and Treasury on January 22, 2024," wrote the lawmakers in a letter to America's Health Insurance Plans (AHIP)-whose membership includes major health insurers across the country-and UnitedHealth Group.

Despite the ACA's protections, the members outlined how multiple investigations-including by the House Oversight Committee, "have revealed that plans routinely violate the ACA by refusing to cover certain products, imposing administrative hurdles like prior authorizations and step therapy (fail first protocols), and requiring patient cost-sharing."

In response to these violations, the Biden Administration recently released additional guidance, outlining a standard that requires coverage without cost-sharing of every FDA-approved product that does not have a therapeutic equivalent (generic). To ensure women can access the birth control they need, the members urged insurance plans to immediately adopt this standard and comply with the law.

The letter has been endorsed by: Planned Parenthood Federations of America, Reproductive Freedom for All (formerly NARAL), Power to Decide, and Physicians for Reproductive Health.

"Under the Affordable Care Act (ACA), comprehensive coverage of birth control is not a suggestion, it's the law. Yet, insurance companies are blatantly disregarding this vital provision," said Gretchen Borchelt, Vice President for Reproductive Rights & Health at the National Women's Law Center. "We support these House and Senate champions for reproductive health in calling for immediate action. It's time for health insurers to uphold their legal obligation and ensure coverage of birth control guaranteed under the ACA. We urge them to adopt the therapeutic equivalence standard outlined by the Departments of Health and Human Services, Labor, and Treasury."

"The new guidance from the Biden-Harris Administration is urgently needed. We thank congressional champions for their continued vigilance in pushing for plans' compliance with the ACA contraceptive coverage requirement and holding those in violation accountable," said Power to Decide CEO, Raegan McDonald-Mosley, MD, MPH. "As a practicing OB-GYN, I know how frustrating it is for my patients to not have the contraceptive they need covered by the health insurance they pay for. Finding a birth control method that works for you takes time, and having a method denied by insurance is a significant barrier that often prevents people from getting the contraception they need."

Read the full letter HERE.