The Contraceptive Equity Act expands access to No Co Pay Birth Control! 

Even under the Affordable Care Act, health insurers may still require copayments on many forms of contraception. For an individual facing financial challenges, these copayments can be a real barrier to obtaining the contraception that works best for them. The bill would ensure that there would be at least one option without copayment in every therapeutically equivalent category on the formulary. So a patient and their provider can choose the therapeutically best option without facing cost barriers.

It is important to note that a health insurer will retain an essential tool to manage costs. If two options are essentially identical, but have a variance in cost, the health insurer can incentivize the consumer to select the lower cost option. The lower-cost option would have no copayment, while the higher cost option could have a copayment.

A health insurer and Medicaid will not be able to require a consumer to obtain approval of coverage before obtaining long-acting reversible contraception (LARC) methods, including intrauterine devices (IUDs) and implants. The CDC recommends that administrative and logistical barriers to LARC, including pre-approval requirements, be removed.

Before January 1, 2018, a health insurer could limit the number of months of birth control pills or other forms of contraception that an individual can obtain. When a patient faces transportation problems or has a difficult working schedule, they may not be able to obtain their contraception, leaving them at risk for unintended pregnancy. There is evidence that providing more months of contraceptives leads to higher rates of continuation and significantly fewer unplanned pregnancies.

* Some insurers may require a 2-month “trial” period for new prescriptions before paying for a full 6 months.

The law extends vasectomy coverage requirements to the rest of Maryland’s insurance market. If vasectomies are covered, there will be no cost–sharing requirements.

Right now, the ACA requires health insurance to cover all contraceptive medications with a prescription. However, if the same medication is available over-the-counter, then there are no coverage requirements such as Plan B.

An individual may need coverage of a contraceptive that is not on an insurer’s formulary. Maryland law already provides that an insurer has to provide coverage for a drug not on a formulary if the side effects are less. However, Maryland law does not include a provision required by the Affordable Care Act. Insurers must also cover a contraceptive off formulary if the consumer would have an easier time adhering to the regimen of taking that particular drug.