Blue Cross and Blue Shield of Illinois

Blue Cross and Blue Shield of Illinois

 

 

May 3, 2013

Legislative Update
Affordable Care Act Question of the Week: Contraceptive Coverage

The “Question of the Week” provides answers to frequently asked questions regarding the Affordable Care Act (ACA). We hope you find this information helpful.

This week, we are featuring a two-part question about coverage for contraceptives. Eligible benefit plans include coverage under ACA for contraceptives to be covered without cost-sharing for plan/policy years beginning on or after Aug. 1, 2012, for non-grandfathered plans. If you have a question about an ACA provision, contact your account representative.
 
Why aren't we covering all contraceptives?
The ACA provision does not mandate that all drugs and devices be covered. The rules governing coverage of preventive services allow plans to use reasonable medical management to help define the nature of the covered service. 

We have identified one or more products within each of the 11 FDA-approved methods of contraception that will be covered without cost-sharing. However, we are not covering all drugs and devices without cost-sharing.

View our Comprehensive Contraceptives List.

Why are some covered contraceptives a brand name and others are generic?
Under the ACA provision, plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost sharing for branded drugs, if a generic version is available and just as effective and safe.

In the event a member wants to determine the cost of drugs and devices that are not covered without cost-sharing, the Prime Therapeutics website has an interactive tool for calculating the cost of items per plan.


 

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