New Guidance from PA for Health Insurers to Improve Coverage for Over-the-Counter Contraception

Governor Josh Shapiro urged health insurers in Pennsylvania to make contraception more accessible and affordable, announcing new guidance on insurance coverage that may save women nearly $250 a year for over-the-counter (OTC) contraception.

With the launch of the first ever FDA approved OTC daily birth control pill, Opill, Pennsylvania insurers are strongly encouraged to cover OTC contraceptives with or without a prescription, and are being asked to exempt this medication from the lengthy drug exceptions process as a best practice.

“For millions of women, birth control represents personal freedom and the ability to make choices over their own bodies. Now it’s time that insurance companies step up – I believe no one should be denied access to birth control because they can’t afford it,” said Governor Josh Shapiro. “That’s why my Administration is issuing guidance to health insurers that it is now best practice for plans to provide coverage for over-the-counter contraception with or without a prescription. If insurers don’t cover over the counter contraception, our Administration’ will ask for additional information on why not – and the Department will be pushing back to make sure exception processes aren’t preventing women from obtaining reproductive healthcare, and fully comply with federal law.”

If an insurer chooses not to cover OTC contraception options, the Pennsylvania Insurance Department (PID) will require them to provide additional information to verify compliance with federal law and regulations, assessing why OTC contraception is not covered by the health care plan.

“PID will be pushing companies to make sure exception processes aren’t preventing women from obtaining reproductive healthcare” said Pennsylvania Insurance Commissioner Michael Humphreys. “The U.S. Congress has identified opportunities for insurers to improve access to contraceptive care. PID, too, has identified that such opportunities exist among Pennsylvania’s health insurance plans. We can do better.”

The FDA recently approved the Opill (norgestrel) tablet for nonprescription use to prevent pregnancy, providing an option for Pennsylvanians to purchase this medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The medication currently costs around $20 for a one-month supply.