Washington State Office of the Insurance Commissioner

Insurance coverage for contraceptives


All state-regulated health insurance plans that provide comprehensive prescription drug coverage also must cover prescription contraceptives.

Understand your rights

  • A health carrier cannot restrict, exclude, or reduce coverage or benefits under any health plan on the basis of sex.
  • If a health plan which provides generally comprehensive coverage of prescription drugs and prescription devices then it must also cover FDA-approved prescription contraceptives and devices.
  • Coverage of prescription contraceptives includes coverage for medical services associated with the prescribing, dispensing, delivery, distribution, administration and removal of a prescription contraceptive to the same extent, and on the same terms, as other outpatient services.
  • A health plan cannot offer less coverage for prescription contraceptives than it does for other prescription drugs and prescription devices.
  • Health plans cannot impose benefit waiting periods, limitations, or restrictions on prescription contraceptives that are not required or imposed on other covered prescriptions
    drugs and prescription devices.
  • Health plans may require co-payments and/or deductibles for prescription contraceptives
    and associated services to the same extent that they require it for other prescription
    drugs, devices and/or services.
  • A health plan may limit contraceptive coverage to a closed formulary if they otherwise
    use a closed formulary, but the formulary must include each type of contraception as
    defined by this rule.

What contraceptives are covered?

United States Food and Drug Administration (FDA) approved contraceptive drugs, devices
and prescription barrier methods, including contraceptive products declared safe and effective
for use as emergency contraception by the FDA.

 



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