Politics & policy

Insight into federal and state health care legislation & CMS regulation

Legislating contraception coverage

Legislation before Congress would require health plans that provide prescription drug benefits to cover FDA-approved prescription contraceptives. The bill is modeled on a Maryland law that took effect last April, when that state became the first to require commercial plans to cover contraceptives when they offer a prescription drug benefit. Since then, six other states have enacted mandates for contraceptive coverage; legislation is pending in 16 more states.

A recent study indicated that 84 and 81 percent of HMOs routinely provide coverage for oral contraceptives and diaphragms, respectively, while 86 and 88 percent cover tubal ligation and vasectomy, respectively. Coverage by indemnity plans drops to 33 and 21 percent for oral contraceptives and diaphragms, respectively; sterilization rates are similar, however, at 86 and 85 percent for tubal ligation and vasectomy, respectively.

SOURCE: NATIONAL SURVEY ON INSURANCE COVERAGE OF CONTRACEPTION, KAISER FAMILY FOUNDATION, MENLO PARK, CALIF., 1998

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