Federal Officials Propose ASHP-Supported Rules to Expand Coverage for Contraception, PrEP

This week, the Department of Health and Human Services (HHS) proposed new rules to promote patient access to recommended preventative services, including contraception and pre-exposure prophylaxis (PrEP), at no cost to patients — changes that are consistent with ASHP policy.

The proposed rules, “Enhancing Coverage of Preventive Services Under the Affordable Care Act,” are a joint agency effort by HHS and the Departments of Labor and the Treasury to standardize coverage requirements for preventive services across group health plans and health insurers.

If finalized, the proposal would expand coverage, without cost-sharing, to over-the-counter contraception, including emergency contraception, and prescribed contraception. It would also require increased transparency for patients about coverage of and access to contraception. The rule also expands coverage to all Food and Drug Administration-approved formulations of medications for PrEP, as recommended by the United States Preventive Services Task Force. The proposal provides additional guidance for insurers related to reasonable medical and utilization management techniques for these services.

These actions are consistent with ASHP’s policies, Over-the-Counter Availability of Hormonal Contraceptives and Pharmacist Prescribing Authority for Antiretroviral Therapy for the Prevention of HIV/AIDS, which advocate for coverage policies that ensure patient access to these preventative therapies is not compromised.

“We applaud efforts to increase patient access to hormonal contraception and PrEP,” said Tom Kraus, ASHP vice president of government relations. “We are taking a close look at the proposed rules to ensure that these changes fully incorporate established pharmacist-led access to these important preventative services.”

ASHP will be reviewing and responding to the proposed rules over the next 60 days. We will be carefully evaluating any unintended consequences for patients living in the states that allow pharmacist-prescribed access to contraceptives, PrEP, and other preventative services. Email Anna Legreid Dopp, ASHP senior director of government relations, with questions or concerns about the proposal.