BuzzFeed News

Reporting To You


Insurers: The New Contraceptive Access Study That Politicians Are Citing Is Flawed

The health industry's leading trade group is going after a new study that says insurers are violating Obamacare's contraceptive coverage mandate.

Posted on May 10, 2015, at 10:01 p.m. ET

Charles Dharapak / AP

Health insurers are attacking a new study that accuses insurers of not complying with the Affordable Care Act's contraceptive mandate — the study, the insurers argue, is based on anecdotal evidence partly paid for by a drug company.

The source of the dispute is a study released last month by the National Women's Law Center, a nonprofit that advocates on women's issues. The report, which provided anecdotal evidence and a review of health insurance plans in 15 states, concluded that insurance companies were in many cases violating Obamacare's requirement that health insurers cover FDA-approved methods of contraception at no cost to the patient.

The report has had a big impact: Lawmakers in New York are already talking about changes to the state's coverage requirements, while on Capitol Hill, a number of senators have written the Department of Health and Human Services, calling for clarifications about Obamacare's contraceptive requirement.

But health insurers say the study is flawed and too strongly weighs a wider range of contraceptive options and brand-name contraceptives — things that drug companies want — with ramifications that involve, insurers say, more money needlessly spent on expensive contraceptives, when there are more cost effective, and medically legitimate, methods available

The insurers also take issue with the methodology behind the National Women's Law Center report. The anecdotal evidence in the report was acquired, in part, through the center's "Cover Her" hotline — a service that offers guidance to women who are still paying out-of-pocket for contraceptives. That service is partly funded by grants from Bayer Healthcare, a drug company that makes a variety of brand name contraceptives.

The insurers say the interests of Bayer — promoting its brand-name products — is a problem. In a statement to BuzzFeed News, a representative for America's Health Insurance Plans, the industry's largest trade group, argued drug companies are trying to shift the conversation away from the prices of their contraceptive drugs while promoting more access to their products with no out-of-pocket fees for the patient.

"As prescription drug prices escalate, drug makers are looking for every opportunity to silence the debate on the impact these costs have for consumers," said Clare Krusing, director of communications for AHIP. "They are playing a shell game on patients by pushing proposals to change prescription drug coverage without addressing the price of these products and treatments."

An official with the National Women's Law Center told BuzzFeed News that the study's other funders more broadly support the hotline and the Center's advocacy efforts, and that neither the organization nor "Cover Her" endorses any Bayer products. A representative for Bayer confirmed their involvement in the "Cover Her" campaign to BuzzFeed News and said the company wants to promote access to contraceptives across the board.

If the pharmaceutical industry's intended goal is, as the health industry alleges, to shift the conversation away from drug prices in favor of promoting access to their products with no out-of-pocket costs, then at least for now, their efforts appear to be working.

In response to the report, New York Attorney General Eric Schneiderman on Monday will introduce legislation that, if passed, will reinforce and expand on provisions in the Affordable Care Act designed to increase access to contraceptive care for patients with no additional costs.

The bill would, among other things, require health insurance policies in the state of New York to cover men's contraceptive treatment with no out-of-pocket costs, prohibit insurance companies from "medical management" review of contraceptive coverage, and allow for the dispensation of a year's worth of a contraceptive at a time.

Additionally, last Tuesday, Democratic Sen. Patty Murray, along with 38 other Senate Democrats, sent a letter to Health and Human Services Secretary Sylvia Burwell requesting the department to issue clearer guidance on the mandate and proactively encourage compliance.

At the heart of this conflict is a significant disagreement between health insurers and women's health advocates over what the ACA's contraceptive mandate actually requires. The National Women's Law Center, as part of its report, argues that the law requires insurance companies to cover 20 different FDA-approved contraceptive methods at no cost to the patient. The organization has called on HHS to clarify their guidance.

Health insurers, on the other hand, often operate using a much narrower list of approved methods and contend that the law gives insurers leeway to use "medical management" techniques to control costs while providing care to their patients.

Rising drug prices and their effect on the cost of health care have long been a concern for health insurers and consumers alike. And while most Democrats who are talking about contraception coverage seem focused on increasing access, there is one prominent member of the party talking about controlling rising drug prices: Hillary Clinton.

"We need to drive a harder bargain negotiating with drug companies about the costs of drugs," Clinton said in Iowa earlier this year.

The Obama administration issued new guidance Monday clarifying how the ACA's contraception mandate should be implemented. Specifically, the administration said that health insurers must cover all 18 FDA approved methods of contraception and not use the more limited categories that some insurance companies currently cover.

Support our journalism

Help BuzzFeed News reporters expose injustices and keep quality news free.