With federal regulators seeking public input on the potential benefits, costs, and implementation considerations of requiring private health insurance plans to cover over-the-counter preventive products without a prescription, a new KFF post explores the issues relevant to covering over-the-counter contraceptives. These contraceptives include Opill, the first daily oral contraceptive pill to receive FDA approval for over-the-counter availability.
The analysis draws on the lessons learned from KFF staff interviews with more than 80 key players nationally and in states that have passed laws or taken other actions to expand access to birth control without a clinician’s prescription. It describes implementation challenges and strategies including standardized billing protocols for over-the-counter products, enrollees and pharmacists’ awareness of required coverage, and the impact of mitigating pharmacist and pharmacy staff overload.
Under current federal policy guidelines, insurers are generally required to cover prescribed FDA-approved contraceptives with no patient cost-sharing. In October 2023, the Departments of Treasury, Labor, and Health and Human Services issued a request for information related to requiring private insurers to cover over-the-counter preventive services and supplies without a prescription. Comments on the proposal are due on December 4.