Health insurers would be required to cover over-the-counter (OTC) contraceptives without cost sharing or a prescription, under a rule proposed by the Centers for Medicare & Medicaid Services (CMS).
Under the Enhancing Coverage of Preventive Services Under the Affordable Care Act proposed rule, CMS would require health plans to cover OTC contraceptive items, based on:
- United States Preventive Services Task Force recommendations
- Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
- Preventive care and screenings for infants, children, and adolescents recommended by the Health Resources and Services Administration (HRSA)
- Preventive care and screenings for women, as supported by HRSA guidelines
Further, CMS has proposed requiring plans and issuers to add a disclosure to the results of any transparency in coverage self-service tool search for covered contraceptives.
Proposed coverage requirements would be applicable to plan years beginning on or after Jan. 1, 2026. Comments are due 60 days after the rule is published in the Federal Register.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.