Years of Systemic Noncompliance by Insurers Has Wrongfully Forced Out-of-Pocket Payments

Text of Letter (PDF)

BOSTON – Today, Congresswoman Ayanna Pressley (MA-07), Policy Co-Chair of the Democratic Women’s Caucus (DWC), joined DWC Chair Lois Frankel (FL-22), Policy Co-Chair Kathy Manning (NC-6), and Pro-Choice Caucus Contraception & Family Planning Task Force Chair Judy Chu (CA-28), along with Senators Elizabeth Warren (D-MA), Catherine Cortez Masto (D-NV), and Tina Smith (D-MN), in leading over 150 House and Senate Democratic colleagues in urging health insurers to fully comply with the Affordable Care Act (ACA) contraception coverage requirement. Specifically, the members urged insurers to adopt a “therapeutic equivalence standard” ensuring coverage—without cost sharing—of every FDA-approved birth control product that does not have a therapeutic equivalent (generic). The letter comes after years of systemic noncompliance by insurance plans, forcing women to pay out of pocket or face administrative red tape to access the birth control that works best for them.

“We write to express our concerns that your members are not complying with the Affordable Care Act contraception coverage requirement, and to urge them to consider immediate adoption of the therapeutic equivalence standard outlined by the Departments of Health and Human Services, Labor, and Treasury on January 22, 2024,” wrote the lawmakers in a letter to America’s Health Insurance Plans (AHIP)—whose membership includes major health insurers across the country—and UnitedHealth Group.  

“We must affirm the fundamental right to make decisions about our body—and that includes protecting access to birth control,” said Rep. Pressley in a statement alongside the letter. “Insurers must comply with the ACA’s contraception coverage requirements, and we must keep pushing to pass my Affordability is Access Act to make sure over-the-counter birth control is fully covered by insurers without any fees or out-of-pocket costs.”

Despite the ACA’s protections, the members outlined how multiple investigations—including by the House Oversight Committee, “have revealed that plans routinely violate the ACA by refusing to cover certain products, imposing administrative hurdles like prior authorizations and step therapy (fail first protocols), and requiring patient cost-sharing.”

In response to these violations, the Biden Administration recently released additional guidance, outlining a standard that requires coverage without cost-sharing of every FDA-approved product that does not have a therapeutic equivalent (generic). To ensure women can access the birth control they need, the members urged insurance plans to immediately adopt this standard and comply with the law.

The letter has been endorsed by: Planned Parenthood Federations of America, Reproductive Freedom for All (formerly NARAL), Power to Decide, and Physicians for Reproductive Health.

“Under the Affordable Care Act (ACA), comprehensive coverage of birth control is not a suggestion, it’s the law. Yet, insurance companies are blatantly disregarding this vital provision,” said Gretchen Borchelt, Vice President for Reproductive Rights & Health at the National Women’s Law Center. “We support these House and Senate champions for reproductive health in calling for immediate action. It’s time for health insurers to uphold their legal obligation and ensure coverage of birth control guaranteed under the ACA. We urge them to adopt the therapeutic equivalence standard outlined by the Departments of Health and Human Services, Labor, and Treasury.”

“The new guidance from the Biden-Harris Administration is urgently needed. We thank congressional champions for their continued vigilance in pushing for plans’ compliance with the ACA contraceptive coverage requirement and holding those in violation accountable,” said Power to Decide CEO, Raegan McDonald-Mosley, MD, MPH.  “As a practicing OB-GYN, I know how frustrating it is for my patients to not have the contraceptive they need covered by the health insurance they pay for. Finding a birth control method that works for you takes time, and having a method denied by insurance is a significant barrier that often prevents people from getting the contraception they need.”

A copy of the letter can be found here.

Rep. Pressley, along with Senator Patty Murray (D-WA) and Reps. Alexandria Ocasio-Cortez (NY-14) and Ami Bera (CA-06), is the lead sponsor of the Affordability is Access Act, legislation to ensure that once the FDA determined an over-the-counter birth control option to be safe, insurers fully cover over-the-counter birth control without any fees or out-of-pocket costs.

In her time serving in Congress, Rep. Pressley has fought persistently to protect fundamental reproductive and sexual health care rights. 

• Rep. Pressley is the lead co-sponsor of the Abortion Justice Act, sweeping, intersectional legislation to address access to abortion care and put forth a comprehensive vision of a just America where abortion care is readily available—without stigma, shame or systemic barriers—for all who seek it, regardless of zip code, immigration status, income, or background.
• Rep. Pressley is a lead co-sponsor of the Women’s Health Protection Act (WHPA), bicameral federal legislation to guarantee equal access to abortion care, everywhere. 
• Rep. Pressley is also a lead co-sponsor of the EACH Act, bold legislation to repeal the Hyde Amendment and help guarantee abortion coverage—regardless of how a patient gets their health insurance.
• Shortly before the Supreme Court’s overturning of Roe v. Wade, Rep. Pressley led a group of her Black women colleagues in writing to President Biden urging him to declare a public health emergency amid the unprecedented threats to abortion rights nationwide. 
• Rep. Pressley condemned the Supreme Court’s leaked draft opinion to overturn Roe v. Wade., and implored the Senate to protect abortion rights and slammed the white supremacist roots of anti-abortion efforts.
• In August 2023, Rep. Pressley issued a statement on the Fifth Circuit Court decision in Alliance for Hippocratic Medicine v. FDA.
• In July 2023, Rep. Pressley, alongside Senator Patty Murray (D-WA), Rep. Cori Bush (MO-01), and Senator Tammy Duckworth (D-IL), reintroduced the Reproductive Health Care Accessibility Act, legislation to help people with disabilities—who face discrimination and extra barriers when seeking care—get better access to reproductive health care and the informed care they need to control their own reproductive lives.
• In July 2023, Rep. Pressley applauded the Food and Drug Administration’s (FDA) approval of over-the-counter birth control.
• In May 2023, Rep. Pressley applauded the FDA Advisory Committee’s unanimous, 17-0 vote to recommend the approval of the first-ever application for over-the-counter birth control. She and Senator Murray also held a press conference applauding the decision and urging the FDA to approval over-the-counter birth control without delay.
• In May 2023, Rep. Pressley, along with Representatives Alexandria Ocasio-Cortez (NY-14) and Ami Bera, MD (CA-06) and Senators Mazie Hirono (D-HI) and Catherine Cortez Masto (D-NV), reintroduced their bicameral Affordability is Access Act to ensure that once the FDA determines an over-the-counter birth control option to be safe, insurers fully cover over-the-counter birth control without any fees or out-of-pocket costs.
• In April 2023, Rep. Pressley issued a statement condemning the Texas court ruling on mifepristone, and discussed the Texas case in a recent floor speech in which she affirmed medication abortion as routine medical care and access to mifepristone as essential. She later joined Governor Maura Healey, Senator Elizabth Warren (D-MA), and local leaders in announcing action to protect Mifepristone in Massachusetts.
• In March 2023, Rep. Pressley, along with Senator Cory Booker (D-NJ) and Reps. Schakowsky, Lee, DeGette, Torres and Strickland, reintroduced the Abortion is Healthcare Everywhere Act harmful and discriminatory Helms Amendment and expand abortion access globally.
• In March 2023, Rep. Pressley and Senator Hirono led their colleagues in reintroducing a bicameral congressional resolution honoring abortion providers and clinic staff. 
• In March 2023, Rep. Pressley delivered a speech in which she discussed the pending court case in Texas, which aims to restrict access to medication abortion across the entire nation. In her remarks, Rep. Pressley affirmed medication abortion as routine medical care, and accessibility to the abortion pill mifepristone as essential.
• In September 2021, Rep. Pressley issued a statement condemning the Supreme Court’s inaction on SB-8, Texas’ restrictive abortion law. Later that month, she participated in a House Oversight Committee hearing to examine the threat posed by abortion bans and underscored the urgency of the Senate passing the Women’s Health Protection Act. 
• In April 2021, Rep. Pressley, along with Congresswomen Barbara Lee (CA-13), Diana DeGette (CO-01) and Jan Schakowsky (IL-09), led a group of 131 Democratic members in reintroducing the Equal Access to Abortion Coverage in Health Insurance Act or the EACH Act, which would repeal the Hyde Amendment and ensure that all people, regardless of income, insurance or zip code, can make personal reproductive health care decisions without interference from politicians. She re-Introduced the legislation In January 2023.
• Rep. Pressley has led calls in Congress for the FDA to remove medically unnecessary restrictions on the medication abortion drug mifepristone, and applauded the FDA’s action in January 2023 to allow retail pharmacies to dispense abortion medication pills.
• As Chair of the Pro-Choice Caucus’s Abortion Rights and Access Task Force, Congresswoman Pressley has led the fight to repeal the Hyde Amendments from annual Labor, Health and Human Services, Education and Related Agencies appropriations bills and in July 2020 published a Medium post on the importance of doing so. She applauded the removal of the Hyde Amendment in President Biden’s FY2022 budget.
• In May 2020, she led more than 155 Members of Congress in calling on House Democratic leadership to ensure that any future COVID-19 relief packages rejected Republican efforts to use the public health crisis to diminish abortion access.
• In August 2021, Rep. Pressley, Oversight Chairwoman Carolyn Maloney, and Pro-Choice Caucus Co-Chairs Reps. Diana DeGette and Barbara Lee led more than 70 of their House Democratic colleagues in introducing a resolution in support of equitable, science-based policies governing access to medication abortion care. 
• In January 2023, Rep. Pressley introduced a resolution to condemn all forms of political violence in the U.S., regardless of its target or intent. That same day, she delivered a powerful speech on the House floor slamming Republicans’ harmful, misleading anti-abortion resolution.
• In September 2022, Rep. Pressley hosted U.S. Department of Health and Human Services Secretary Xavier Becerra at the Codman Square Health Center in Dorchester for a convening on their work to address the Black maternal health crisis and the criminalization of abortion care in states across the nation following the harmful U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health. 
• In May 2019, she led more than 100 colleagues in introducing H.Con.Res.40, a resolution reaffirming the House of Representative’s support for Roe v. Wade.
• In June 2019, Rep. Pressley introduced H.R. 3296, the Affordability is Access Act, to make oral contraception available without a prescription. 
• In September 2016, as a member of the Boston City Council, Pressley championed a resolution calling on Congress and President Obama to repeal the Hyde Amendment and reinstate insurance coverage for abortion services.

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