Some insurers are requiring women to pay all of the costs of their contraceptive drugs even though Obamacare requires birth control to be provided free of charge, according to a study released Thursday that blames vague federal guidelines for the uneven implementation.
The contraceptive provisions, one of the most controversial parts of the Affordable Care Act, were supposed to give women free access to birth control.
But some insurers are picking and choosing what drugs or devices they will cover, leaving women who want different kinds of birth control to pay out of their own pockets, said the nonpartisan Kaiser Family Foundation, which conducted the study.
“There are still some women who are not fully benefiting from this tremendous advance for women’s health,” said Gretchen Borchelt, a vice president at the National Women’s Law Center who spoke at the study’s release.
Most of the 20 insurers studied covered the full cost of the Plan B “morning after” pill or its generic types, but 11 insurers covered only part of the cost of another emergency contraceptive, Ella, and two insurers didn’t cover it at all.
The pill, which has no generic equivalent, has a longer window to work than Plan B.
Ten carriers covered all three of the intrauterine devices approved by the Food and Drug Administration without cost-sharing, but one did not cover ParaGuard, the only nonhormonal IUD available.
The Obama administration promised that rules are on the way to clear up the confusion.
“The administration strongly supports ensuring that women can access contraceptive services as authorized by the women’s preventive services provision in the ACA,” spokeswoman Katie Hill said. “We appreciate the importance of this issue and plan to release more guidance soon.”
For now, doctors are spending a lot of time negotiating with insurers, and women end up dealing with confusion at the pharmacy counter.
“Finding out in the pharmacy that [a drug is] not covered is kind of a big problem,” said Edward Anselm, a consultant medical director for Health Republic Insurance of New Jersey.
Most of the controversy surrounding the contraceptive mandate has been the marathon court battle between the administration and employers who have religious objections to contraceptives and say forcing them to pay for employees’ coverage violates their own rights.
The Supreme Court last year ruled that closely held corporations should be exempt from insuring contraceptives that violate their beliefs, and the Obama administration is expected to update its rules soon.
Religious nonprofits are still pursuing their cases through the courts, arguing that the “accommodation” the administration designed for them still leaves them complicit in contraceptive coverage.
Kaiser, however, looked at the contraceptive mandate from the side of female customers. The analysts did not identify the insurers they studied. They said carriers participated in exchange for confidentiality and that major industry players were involved.
Kaiser did not include regular oral contraceptives in its study, saying the analysis would be too complicated.
At issue is what the federal government intended in its guidance on Obamacare’s birth control component. The guidance allows insurers to apply “reasonable medical management” to control their costs, but the concept is ill-defined, Kaiser researchers said.
Health insurers said the federal government didn’t insist that every single drug or patch needs to be covered at no cost to the consumer. A generic drug may be offered without cost-sharing while a brand-name equivalent might not, for instance, and plans generally offer an array of options, according to America’s Health Insurance Plans.
“Health plans provide access to a full range of FDA-approved contraceptive methods as required under the ACA. It’s important that women have access to safe, effective treatments that meet their health needs in the most affordable way possible,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans.
But Ms. Borchelt said the government wanted women to have choices and limited options violates the intent of the law.
“I think the guidance is less clear than the plans seem to think it is,” she said.