policy

On December 20, ACAP submitted comments on the Enhancing Coverage of Preventive Services Under the Affordable Care Act Proposed Rule issued by the Internal Revenue Service, the Employee Benefits Security Administration, and the Health and Human Services Department.

The letter shares appreciation for the Administration’s desire to ensure that all preventive services to which section 2713 of the Public Health Service Act applies are covered without cost-sharing by non-grandfathered group or individual health insurance coverage and non-grandfathered group health plans, including over the counter (OTC) contraceptive products.

The letter suggests improvements to the final rule, including:

•A finalization of the proposed inclusion of existing regulations and guidance that allow insurers to apply reasonable medical management techniques for OTC products, including OTC contraceptives, and permit plans to require that an attending provider be involved in an exceptions process for an OTC contraceptive.
• Providing plans at least one year of lead time from the rule’s effective date (and any relevant implementing guidance) before the OTC contraceptive requirement takes effect, to accommodate necessary system changes by plans, issuers, and retailers alike. In other words, we ask that this requirement take affect no sooner than January 1, 2027 (as opposed to January 1, 2026, as proposed.) We believe the other proposed implementation deadlines in the proposed rule are reasonable.
• Providing guidance for how pharmacy counter transactions for OTC item claims are processed to reduce pharmacist burden and promote consistency.

Read the letter in full, including expanded comments, via the sidebar to the right.