Pennsylvania Insurance Department will hold insurers accountable, requiring additional information from companies who chose not to cover OTC contraception with or without a prescription.
Harrisburg, PA – The Shapiro Administration, in support of women's freedom to make their own health care decisions, urged health insurers in Pennsylvania to make contraception more accessible and affordable, providing guidance on insurance coverage that may save women nearly $250 a year for over-the-counter (OTC) contraception.
With the launch of the first ever FDA approved OTC daily birth control pill, Opill, Pennsylvania insurers are strongly encouraged to cover OTC contraceptives with or without a prescription, and are being asked to exempt this medication from the lengthy drug exceptions process as a best practice.
If an insurer chooses not to cover OTC contraception options, the Pennsylvania Insurance Department (PID) will require them to provide additional information to verify compliance with federal law and regulations, assessing why OTC contraception is not covered by the health care plan.
Read about how the Shapiro Administration is championing women's right to choose through this new guidance:
PennLive: Make OTC birth control pills more accessible: Shapiro urges health insurers
By Ivey DeJesus
Now that the federal government has rolled out the first over-the-counter contraception, Gov. Josh Shapiro is urging health insurance companies in the commonwealth to make contraception more accessible and affordable with or without a prescription.
On Monday, as the newly approved over-the-counter daily birth control pill, Opill, became available at drug and grocery stores and, even on Amazon, Shapiro issued guidance on insurance coverage that could save women nearly $250 a year for over-the-counter contraception.
“For millions of women, birth control represents personal freedom and the ability to make choices over their own bodies," Shapiro said. “Now it's time that insurance companies step up – I believe no one should be denied access to birth control because they can't afford it."
Daily oral contraceptive pills have historically only been available with a prescription in the U.S. The Food and Drug Administration last year approved the first over-the-counter daily oral contraceptive pill, eliminating the requirement for a prescription from a clinician.
In addition to pregnancy prevention, oral contraceptive medications are used to address other health conditions, particularly menstrual-related disorders such as menstrual pain, irregular menstruation, fibroids, endometriosis-related pain, and menstrual-related migraines.
Shapiro underscored his commitment to advancing and protecting reproductive rights on Monday with a visit to a Philadelphia Planned Parenthood health center, his first such visit since becoming governor.
Shapiro's administration is urging Pennsylvania insurers to cover over-the-counter contraceptives with or without a prescription, and to exempt the newly approved daily medication from the list of drug exceptions.
Shapiro said his administration would ensure that the exception processes are not preventing women from obtaining reproductive healthcare and fully comply with federal law.
“As your governor, I'm always going to protect reproductive health and a woman's right to make decisions over her own body — and we will continue holding folks accountable to defend affordable access to healthcare," Shapiro said.
The newly rolled out Opill, costs around $20 for a one-month supply, and marks the first time ever that a hormonal birth control pill is available over-the-counter.
If an insurer chooses not to cover over-the-counter contraception, the Pennsylvania Insurance Department would require the company to verify compliance with federal law and regulations, in an effort to determine why the over-the-counter contraception is not covered by the health care plan.
Experts say access to Opill will benefit women who live in remote rural areas or face transportation hurdles.
Approximately one-third of women who use hormonal contraceptive have missed taking their birth control because they were not able to get their next supply on time, the Kaiser Family Foundation found in a 2022 Women's Health Survey. An estimated more than 19 million women of reproductive age in need of publicly-funded contraception live in an area considered to be a contraceptive desert, meaning there is limited access to a publicly-funded provider who offers contraception, KFF found.
Access to reliable, long-term over-the-counter contraceptive care removes one of the many barriers that exist to bodily autonomy, said Signe Espinoza, Planned Parenthood Southeastern PA interim vice president of public policy and advocacy.
“Every step we take toward putting reproductive health decisions into patients' hands is a positive one, and this news is great cause for celebration; however, it's not the final step," she said. “There is more to be done in guaranteeing universal insurance coverage of contraceptive care, providing access to sex education in our schools, and eliminating unnecessary regulations and barriers to abortion."
Pennsylvania Insurance Commissioner Michael Humphreys vowed to ensure that exception processes aren't preventing women from obtaining reproductive healthcare.
“The Shapiro Administration is committed to protecting Pennsylvanians' freedom and ensuring they are empowered with choices in their reproductive health care, and covering OTC contraception as a best practice, as a few of our insurers do today, is a nation-leading step forward," Humphreys said.
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