Feb 21, 2018 | Updated: 09:54 AM EDT

Obama Administration Clarifies Birth Control Mandate

May 12, 2015 10:07 PM EDT

As part of Obama Care, health insurers must now cover without cost sharing all 18 forms of contraception listed in the FDA's birth control guide, as stated by the Obama Administration in new guidelines issued on Monday.

"The FDA currently identifies 18 distinct methods of contraception for women, and the ... guidelines are designed to provide women's access to the full range of these contraceptive methods identified by the FDA, as prescribed by a health care provider," stated a fact sheet on the guidance, which was issued jointly by the departments of Labor, Treasury, and Health and Human Services. "Thus, plans and issuers must cover without cost sharing at least one form of contraception within each method the FDA has identified."

For example, the sheet states, "For the hormonal contraceptive methods, coverage must include (but is not limited to) all 3 oral contraceptive methods (combined, progestin-only, and extended/continuous use), injectables, implants, the vaginal contraceptive ring, the contraceptive patch, emergency contraception (Plan B/Plan B One Step/Next Choice), emergency contraception (Ella), and IUDs with progestin. Accordingly, a plan or issuer may not impose cost-sharing on the ring or the patch."

Some employers have objected to the mandate, saying that paying for their employees birth control violates their religious beliefs.  The controversy even made its way to the Supreme Court in the 2014 case Burwell v. Hobby Lobby Stores.  In that case, the highest court in the land ruled that Hobby Lobby should not have to pay for contraceptive coverage.

In a response to employers' concern, the Obama administration came up with a compromise that allows women to get access to contraception directly from insurance companies and the employer would not have to pay for it.  This arrangement still left some employers dissatisfied as it would require employers to sign a form saying they wouldn't pay for it, an act that some employers saw as participating in making the coverage available.

Donna Harrison, MD, executive director of the American Association of Pro-Life Obstetricians and Gynecologists, said her organization had concerns about the guidance.

"The newly issued guidelines ... apparently still require insurers to cover contraceptive drugs and devices known to work after fertilization, such as the IUD and Ella," she wrote in an email to MedPage Today. "These methods clearly can end the life of an unborn child after fertilization, and neither insurance companies nor taxpayers should be forced to pay for drugs and devices which can end a human life."

Others, however, were supportive of the new guidelines. 

"We are grateful to the Administration for acknowledging and taking action to stop harmful and illegal insurance practices that go against standards of care and inappropriately limit contraceptive choices," Susan Berke Fogel, JD, NHeLP's director of reproductive health, said in a statement. "We are especially pleased to see the Administration take steps to end discrimination against transgender individuals."

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