- The Washington Times - Monday, May 11, 2015

New York’s top lawman proposed legislation Monday to write Obamacare’s birth-control requirements into state law, extending no-cost services even to men as watchdogs accused insurers of violating the spirit — if not the letter — of the health overhaul by forcing women to pay out of pocket for their preferred contraceptives.

Attorney General Eric T. Schneiderman said his bill would force every state-regulated health policy to cover all forms of FDA-approved contraceptives, free of cost — a key promise of the Affordable Care Act that’s been called into question by third-party studies that say companies have leveraged ambiguity in federal guidance to charge women for all or part of certain drugs, devices or services.

Emergency, or “morning-after,” pills that some religious groups equate with abortion must be covered under the bill.

The legislation would prohibit insurers from using “medical management” tactics to limit or delay contraception, and it goes beyond Obamacare by extending no-cost services to men. And it would allow let consumers access a year’s worth of contraceptives at a time.

“New Yorkers should not be penalized by their insurance companies for using the birth control method that they and their medical provider agree is most appropriate for them,” Mr. Schneiderman said. “Ensuring comprehensive, cost-free access to birth control is critical to fulfilling the goals of the Affordable Care Act and to upholding every woman’s right to contraception.”

One of the most controversial parts of the Affordable Care Act, the contraceptive provisions were supposed to give women free access to birth control.

But some insurers are picking and choosing what drugs or devices they’ll cover, leaving women who want to choose a different drug or method of birth control to pay costs out of their own pocket, the nonpartisan Kaiser Family Foundation said in a study released last month.

For instance, of the 20 insurers studied covered the full cost of the Plan B “morning after” pill or its generic types, but 11 insurers only covered part of the cost of another emergency contraceptive, “ella,” and two insurers didn’t cover it at all.

The National Women’s Law Centers followed up with a similar study and more matter-of-factly accused insurers of violating the law.

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 — a concept that Mr. Schneiderman attempts to override in his new bill — 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, America’s Health Insurance Plans said in response to the studies.

In a Sunday blog post, AHIP President and CEO Karen Ignagni argued the accusations against insurers are misdirected, saying they’re the ones stressing access and affordability in cost negotiations with drug companies.

“The dream play for drug manufacturers would be a requirement to cover every possible contraceptive therapy for free,” she wrote. “Then no one would have any incentive to question the prices being charged for these medications. Moreover, efforts to inform patients about treatment alternatives that are more clinically safe and effective would be eliminated, and there would be no price negotiation. Mission accomplished for drug manufacturers.”

Mr. Schneiderman, meanwhile, pitched his plan as part of a years-long struggle to make sure contraception is affordable, starting with 2002 reforms that required policies that included prescription coverage to include contraception. Eight years later, Obamacare’s requirements arrived.

“However, despite the ACA’s broad contraceptive coverage requirements, Attorney General Schneiderman’s office has received reports that certain health plans have been imposing co-pays as well as denying full coverage of certain contraceptive methods through ‘medical management,’” state officials said in a statement on Monday’s legislation.

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