How Could the New Biden Regulations Affect Contraceptive Coverage?

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The Biden administration just proposed a new regulation intended to expand contraceptive coverage and make it easier for women to get their preferred contraceptive covered. If finalized, the regulation would allow women to obtain Opill, the first-ever daily oral contraceptive pill available over-the-counter (OTC), as well as emergency contraceptive pills and male condoms, without a prescription at in-network pharmacies without cost sharing–but not until after January 2026. 

The current rules require coverage of prescribed contraceptive supplies, but not coverage of OTC methods including the new Opill or emergency contraceptive pills, like Plan B, without a prescription. An important consideration is that no-cost coverage would only be required if the products are obtained at in-network pharmacies (use of in-network providers is required of all preventive services, not just contraception). If products are obtained at a store without a pharmacy or online, plans do not have to cover them.

The proposed regulation also changes how plans can limit coverage of certain contraceptive methods.  This is a pretty big deal.  Currently, plans must cover at least one of each of the FDA defined methods.  The proposed rule would take a different approach by requiring plans to cover all FDA approved contraceptives without a “therapeutic equivalent” (with the same active ingredients, dosage form, route of administration, and strength).  This means that it could be much easier for women to obtain the contraceptive method that works best for them without having to deal with denials or pre-authorizations.  For example, plans would need to cover all types of IUDs currently available in the US, since none of them has a therapeutic equivalent.

As with all policies, implementation will matter. Awareness of the contraceptive benefit is still low (only 44% of privately insured, reproductive-age women say they knew about this benefit in May 2024). While the regulation would also require plans to provide information about contraceptive coverage in response to an enrollee’s questions, people need to be aware of the benefit to even ask a question about coverage and costs.  The changes in coverage policy proposed by this regulation could also result in a slight increase in premium costs as spending is shifted from consumers to plans, and the Biden Administration is seeking public comment from plans and employers as well as consumers regarding the likely costs of the new policy. 

The Biden Administration can finalize the regulation after the 60-day comment period. However, the Congressional Review Act allows the new Congress and Administration to review and quickly overturn recently implemented regulations, so the outcome of the election will also determine whether this proposed rule will ever take effect.