Comments: New State Regulations on Contraception in QHPs and Medicaid

Posted September 24, 2018 by Amanda Dunker

HCFANY submitted the attached comments in response to proposed regulations that were released by the New York State Department of Health (DOH, which regulates Medicaid) and the New York State Department of Financial Services (DFS, which regulates qualified health plans).

The proposed DOH rule would apply to Medicaid enrollees. It would make contraceptive prescriptions valid for 12 months, which matches commercial insurance practice and research on best practices in dispensing contraception.

The proposed DFS rule would apply to the plans that New Yorkers purchase through the New York State of Health marketplace. The ACA requires these plans to cover at least one type of each form of contraception approved by the FDA. DFS investigated plan compliance with this regulation in 2017 and found that 75 percent of plans were not compliant. The proposed regulations clarify the ACA’s requirements and implement the same requirements at the state level.  They would:

  • Require plans to cover emergency contraception without a prescription and without cost-sharing;
  • Remove a requirement that limits the amount of a contraceptive that can be dispensed to three months when it is the first time the patient has used that type;
  • Create a standard process for providers seeking an exception for their patient when a preferred contraceptive is not covered under their plan; and
  • Require plans to provide members with up-to-date lists of covered contraceptive drugs, devices, and other products in their formularies and include information about tiers or restrictions in how a drug can be accessed.