Dear Dr. Lotvin:
We continue to hear from patients who are experiencing delays and denials for insurance coverage of birth control products they and their health care providers determine are most appropriate for them. The Affordable Care Act (ACA) requires all group health plans and all issuers of group or individual health insurance coverage to cover women’s preventive services, including the full range of FDA approved, cleared, and granted female-controlled contraceptives, without cost-sharing. Thanks to this requirement, over 64 million women have insurance coverage that includes contraception without cost-sharing. However, over the past nine years, thousands of women have reported challenges obtaining covered contraceptive products as guaranteed by the ACA. As one of the largest pharmacy benefits managers (PBMs) in the country, CVS Caremark’s policies regarding claims for birth control products directly affect patients’ ability to get the birth control they need. Patients should not have to jump through burdensome hoops or pay extra just to get the birth control they need to stay healthy and plan a family on their own terms. We therefore ask you ensure your policies are compliant with the law and provide the requested information so we may better understand the scope, evolution, and impact of your policies.
Following reports that insurers were unlawfully denying access to birth control, the U.S. Department of Labor, Department of Health and Human Services, and Department of the Treasury (the Departments) recently released guidance clarifying that insurers must cover all FDA approved, cleared, or granted contraceptive products that are determined by an individual’s provider to be medically appropriate. Additionally, the Health Resources and Services Administration (HRSA) updated the Women’s Preventive Services Guidelines for plan years starting in 2023, to reinforce the importance of covering the full range of FDA approved, cleared, or granted contraceptives as a part of contraceptive care.
Federal law clearly requires group health plans and health insurance coverage to cover the full range of FDA approved, cleared, or granted contraception. As PBMs typically manage the drug benefit for group health plans and health insurance coverage, policies and practices put in place by PBMs on behalf of those plans or coverage determine coverage decisions for patients. We have heard numerous accounts of PBMs requiring prior authorization, denying claims, or asking patients to try multiple forms of contraceptives before approving them for the product recommended by their health care provider. These opaque and burdensome practices run counter to the goals of the ACA - ensuring access to prescription birth control that is free at the point-of-sale.
We write to seek more information on CVS Caremark’s practices around contraceptive coverage and
ensure you are compliant with the law.
Please respond to the following questions and requests for information no later than May 16, 2022:
Please contact Elizabeth Letter (Elizabeth_Letter@help.senate.gov) with Senator Murray’s staff if you
have any contacts about this request. Thank you in advance for your prompt response.
Sincerely,
