WA Court: No State Obligation to Cover All Contraceptives

July 22, 2003 (PLANSPONSOR.com) - Health plans are under no obligation under Washington state law to cover every US Food and Drug Administration-approved prescription contraceptive, the state's high court has ruled.

>Washington-based legal publisher BNA reported that, in doing so, the Washington Supreme Court rejected arguments by plaintiffs, Shulamit Glaubach and Dawn Merydith that Regence BlueShield’s failure to cover all FDA-approved contraceptives constituted discrimination within “covered services,” in violation of the state law. The statutes provide that “all health carriers shall accept for enrollment any state resident within the group to whom the plan is offered and within the carrier’s service area and provide or assure the provision of all covered services regardless of … sex.”

>In their ruling, the justices wrote: “The statutes through all of their permutations show a clear intent to require health carriers to cover all eligible applicants regardless of individual risk factors or most demographic characteristics. We find nothing in the legislative history that indicates the legislature contemplated contraceptive coverage in these two statutes.”

>Applying the plaintiffs’ broad interpretation of “covered services” to the statute could lead to “unlikely, absurd or strained consequences.” the justices contended.

“The major difficulty we find in accepting (plaintiffs’) proposition is the ultimate scope,” the court said. “Under this reasoning, if a plan covered any prescription drug, it must cover nearly all prescription drugs because discrimination based on ‘health condition’ is also prohibited. In essence, this reasoning would require every plan to offer every service, and that does not accord with the general flexibility health insurers have to tailor plans to meet different needs and different resources.”

The case is Glaubach v. Regence BlueShield , Wash., No. 73415.