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Covering Women’s Preventive Care – Part I
Can a plan require a prescription for contraceptive services covered under these new guidelines? The guidelines list contraceptives as a preventive care recommendation, with a note regarding frequency: “as prescribed.” It is not clear whether this means only with a prescription or simply at the intervals suggested by the physician. However, as discussed above, plans are permitted to establish "reasonable medical management techniques" to determine how to provide preventive care services. We think that requiring a prescription for contraceptives (even over-the-counter items) arguably would be such a reasonable medical management technique. Many plans already are requiring a prescription for other over-the-counter preventive care items, such as aspirin for those with heart disease. Similarly, we are seeing plans consider a prescription requirement for contraceptives in order to be covered at 100%. Got a health-care reform question? You can ask YOUR health-care reform legislation question online at http://www.surveymonkey.com/s/second_opinions You can find a handy list of Key Provisions of the Patient Protection and Affordable Care Act and their effective dates at http://www.groom.com/HCR-Chart.html Contributors: Christy Tinnes is a Principal in the Health & Welfare Group of Groom Law Group in Washington, D.C. She is involved in all aspects of health and welfare plans, including ERISA, HIPAA portability, HIPAA privacy, COBRA, and Medicare. She represents employers designing health plans as well as insurers designing new products. Most recently, she has been extensively involved in the insurance market reform and employer mandate provisions of the health-care reform legislation. Brigen Winters is a Principal at Groom Law Group, Chartered, where he co-chairs the firm's Policy and Legislation group. He counsels plan sponsors, insurers, and other financial institutions regarding health and welfare, executive compensation, and tax-qualified arrangements, and advises clients on legislative and regulatory matters, with a particular focus on the recently enacted health-reform legislation. PLEASE NOTE: This feature is intended to provide general information only, does not constitute legal advice, and cannot be used or substituted for legal or tax advice.
Can a plan require a prescription for contraceptive services covered under these new guidelines?
The guidelines list contraceptives as a preventive care recommendation, with a note regarding frequency: “as prescribed.” It is not clear whether this means only with a prescription or simply at the intervals suggested by the physician. However, as discussed above, plans are permitted to establish "reasonable medical management techniques" to determine how to provide preventive care services. We think that requiring a prescription for contraceptives (even over-the-counter items) arguably would be such a reasonable medical management technique. Many plans already are requiring a prescription for other over-the-counter preventive care items, such as aspirin for those with heart disease. Similarly, we are seeing plans consider a prescription requirement for contraceptives in order to be covered at 100%.
Got a health-care reform question? You can ask YOUR health-care reform legislation question online at http://www.surveymonkey.com/s/second_opinions
You can find a handy list of Key Provisions of the Patient Protection and Affordable Care Act and their effective dates at http://www.groom.com/HCR-Chart.html
Contributors:
Christy Tinnes is a Principal in the Health & Welfare Group of Groom Law Group in Washington, D.C. She is involved in all aspects of health and welfare plans, including ERISA, HIPAA portability, HIPAA privacy, COBRA, and Medicare. She represents employers designing health plans as well as insurers designing new products. Most recently, she has been extensively involved in the insurance market reform and employer mandate provisions of the health-care reform legislation.
Brigen Winters is a Principal at Groom Law Group, Chartered, where he co-chairs the firm's Policy and Legislation group. He counsels plan sponsors, insurers, and other financial institutions regarding health and welfare, executive compensation, and tax-qualified arrangements, and advises clients on legislative and regulatory matters, with a particular focus on the recently enacted health-reform legislation.
PLEASE NOTE: This feature is intended to provide general information only, does not constitute legal advice, and cannot be used or substituted for legal or tax advice.
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