The Biden administration is reminding insurers they must fully cover contraceptive coverage after complaints of some payers denying claims for certain products.
The Department of Labor released an updated frequently asked questions document on Monday that outlined requirements for insurers to cover at-home COVID-19 tests. Tucked into the document is a stern reminder of insurers’ requirements under the Affordable Care Act.
The document said it has received numerous reports and complaints that insurers and pharmacy benefit managers have been denying coverage for all or brand name contraceptives even after a doctor is medically necessary. Other reports say that payers have required individuals to fail first using another method of contraception instead of a product that is more medically appropriate for the individual.
Labor said that it is investigating the complaints and wanted to assess its guidance and regulations to ensure additional guidance is warranted.
It said that insurers must cover without any cost-sharing a contraceptive product medically appropriate for the patient, whether or that that item or service is identified in the current birth control guide created by the Food and Drug Administration.
The updated document comes less than a month after Democratic Sens. Patty Murray of Washington and Ron Wyden of Oregon wrote to Biden administration leaders with concerns over reports of denied coverage claims.
“We have heard from patients and providers that some insurers are requiring patients to show they have failed with as many as five different birth control options before the insurer will pay for their method of choice,” the letter said.