Policy opportunities for expanding insurance coverage of over-the-counter contraception

Moving oral contraceptives (OCs) over the counter (OTC) has the potential to improve women's access to contraception, and evidence shows OTC provision of OCs is safe and women are interested in OTC access. But if the retail price is high and/or insurance does not cover the product, an OTC OC may be inaccessible for many women. Under the Affordable Care Act (ACA), most insurance plans are required to cover contraception without cost sharing, but whether coverage of OTC contraceptives is required is unclear. Many state Medicaid programs cover OTC contraceptives, but a prescription is required for federal reimbursement. We explored policy opportunities for obtaining public and private insurance coverage of OTC contraceptives by convening women's health advocates, interviewing stakeholders, and reviewing peer-reviewed and gray literature. Opportunities for obtaining insurance coverage of OTC contraceptives include: getting the Department of Health and Human Services to issue guidance that OTC contraception is covered with no cost sharing under the ACA; working with state insurance exchanges to pilot OTC contraceptive coverage without a prescription; and changing federal Medicaid policy so that state Medicaid programs can receive federal matching funds for OTC contraceptives without a prescription. To ensure access to OTC contraceptives, including a future OTC OC, public and private insurance plans should cover these methods, ideally without a prescription. Research is needed to demonstrate the cost benefits for insurers of OTC coverage. New reimbursement mechanisms are needed so that women do not need a prescription to use their insurance for OTC contraceptives.