Insurance coverage for prescription contraceptives

Most health plans that offer prescription drug coverage in Washington state must cover prescription contraceptives (apps.leg.wa.gov).

Under health reform, all health plans (individual, small employer and large employer) must cover Federal Drug Administration-approved prescription contraceptives prescribed by a medical provider as part of preventive services (www.healthcare.gov). However, this doesn't apply to health plans sponsored by certain exempt religious employers.

What's covered

Plans must provide the same coverage for prescription contraceptives as they do for other prescribed drugs and devices including:

  • Contraceptives on your plan's drug list (also called formulary), if they use a formulary for other covered prescriptions.
  • All medical services associated with prescribing, dispensing, delivery, distribution, administering and removing prescription contraceptives, just as they do for other covered outpatient services.
  • All contraceptive products declared safe and effective for use as emergency contraception by the federal Food and Drug Administration.

Health plans cannot:

  • Restrict, exclude or reduce coverage or benefits on the basis of gender.
  • Impose benefit-waiting periods, limits or restrictions on prescription contraceptives they don't impose on other covered prescribed drugs and devices.

What you pay

You're responsible for any copayments and/or deductibles for prescription contraceptives and associated services, just as you are for other prescription drugs, devices, and/or services.

However, under health reform, all individual and small group plans can't charge you a copay or coinsurance if you receive services from a network provider. This is true even if you don't meet your annual deductible.

Updated 08/21/2014

See also

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