The departments of Health and Human Services (HHS), Labor, and the Treasury issued an Oct. 21 proposed rule that would amend the regulations that require commercial insurance plans to cover certain preventive services (PDF), including over-the-counter (OTC) contraceptives, without patient cost-sharing. The Enhancing Coverage of Preventive Services Under the Affordable Care Act [ACA, P.L. 111-148 (PDF) and P.L. 111-152(PDF)] proposed rule expands coverage of recommended preventive services by group or individual health insurance plans, as required by the ACA. Specifically, the rule would require group and individual health insurance plans and issuers to cover OTC contraceptive items without cost-sharing and without a prescription.
Previous guidance issued by the departments required coverage without cost-sharing for OTC products only when prescribed by a provider. The rule also proposes an exceptions process through which individuals can receive coverage for medically necessary preventive services that are subject to medical management techniques, such as prior authorization, even when such services are not generally covered under the plan or coverage. If finalized, the provisions related to contraceptive coverage would be applicable for plan years beginning on or after Jan. 1, 2026. The departments are accepting public comments on the rule until Dec. 27.