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 Recent published reports found that some payers were ignoring
federal requirements for covering birth control, a benefit under the
healthcare reform commonly referred to as "Obamacare."
On Monday, the Department of Health and Human Services issued a
series of responses aimed at correcting misperceptions or potential
coverage loopholes being exploited by some insurers.
It said a plan that covers some types of contraception, such as
intrauterine devices, or IUDs, but excludes other forms of birth
control would not be in compliance with federal regulations.
The HHS document said a health plan may use "reasonable medical
management techniques" to determine which specific products to cover
if there are multiple FDA-approved options within a contraception
category, such as birth control pills. If a doctor recommends a
particular service or FDA-approved item based on medical necessity,
the plan must cover it without cost-sharing by the patient.
"The FDA currently identifies 18 distinct methods of contraception
for women, and the HRSA 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," the document
said.
The paper also addressed certain genetic testing for cancer risk,
such as those that led actress Angelina Jolie to have pre-emptive
surgery to remove her breasts and ovaries.
The guidelines recommend that women who have a family history of
breast, ovarian, tubal or peritoneal cancer be screened for
increased risk using genetic tests such as those for BRCA1 or
BRACA2. The BRCA tests can help patients assess risk and decide
whether to undergo pre-emptive surgery.
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"As long as the woman has not been diagnosed with BRCA-related
cancer, a plan or issuer must cover preventive screening, genetic
counseling, and genetic testing without cost sharing, if
appropriate, for a woman as determined by her attending provider,"
the paper said.
It also addressed transgender patients, saying preventive care
cannot be limited based on a patient's sex assigned at birth or
gender identity if a physician determines that such a service is
medically necessary, such as providing a mammogram or pap smear for
a transgender man who has residual breast tissue or an intact
cervix.
(Reporting by Bill Berkrot; Editing by Ted Botha)
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