Senators press Biden administration to clamp down on insurers flouting ACA birth control cost-sharing rules

The Biden administration needs to go after insurers that are flouting the Affordable Care Act’s rules that prevent cost sharing for birth control, a pair of Senate committee leaders said.

Democratic Sens. Ron Wyden of Oregon and Patty Murray of Washington sent a letter to the Health and Human Services, Treasury and Labor departments to step up enforcement of the law’s contraception provisions.

“We ask that you issue additional, comprehensive guidance regarding insurers’ responsibilities for contraceptive coverage and that you take swift enforcement action against insurers who fail to comply with those responsibilities,” the lawmakers wrote.

Wyden chairs the Senate Finance Committee and Murray heads up the Senate Health, Education, Labor and Pensions Committee.

Both lawmakers wrote that they have heard from patients and providers that some insurers are demanding “patients to show they have failed with as many as five different birth control options before the insurer will pay for the method of their choice,” the letter said.

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The lawmakers have also heard of multiple reports of denials and unclear exemption processes that prompted concerns about “whether patients are actually getting coverage for birth control without cost-sharing as required by the ACA.”

The Obama administration issued guidance in 2015 that plans must have “easily accessible, transparent and sufficiently expedient exceptions process that is not duly burdensome on the individual or provider,” the letter said.

Insurers also must defer to the provider when determining whether birth control is medically necessary.

“The objective of this exceptions process is to prevent insurers from using cost control tools that prevent women from accessing their preferred method of birth control,” the letter said.