Washington state law requires state-regulated health plans to cover over-the-counter (OTC) birth control with no cost-sharing (copays or deductibles). Prescriptions are not required for OTC birth control for people with a state-regulated health plan.
How to know what type of health plan someone has
It‘s hard for a provider or pharmacist to know whether someone has a state-regulated health plan. Patients will need to call their health plan directly or speak with their human resource administrator at work.
Which OTC birth control methods are covered
Formularies vary from plan to plan, but at least one type of each version of FDA-approved birth control, including condoms and diaphragms, must be covered. Keep in mind that plans may require specific generic versions or limit the amount that’s covered at one time.
Health plans must have an exception process. If your patient is on a form of birth control not on their health plan’s formulary, they can file an exception request to get it covered. They’ll need to contact their health plan for more information on this process.
What if my patient is charged a copay?
Health plans can limit the OTC birth control option to generic types only or limit the amount that is covered at one time. If your patient is charged a copay, they may have picked a birth control that’s not on their plan’s formulary.
How much supply can a patient get at one time?
With a provider’s approval, a patient with a state-regulated health plan can get up to a 12-month supply. However, limiting the supply is within their provider’s medical discretion.
What to do if I can’t make the point-of-sale system work
Tell the person to save their receipt! If they want to get reimbursed, they need to go to their health plan’s website and file a claim for reimbursement. If they still have issues, they should contact their health plan or file a complaint with us.
We are working on solutions to make buying OTC birth control easier for everyone. We encourage you or your patients to contact us with any issues or feedback.