Shapiro announces new rule aimed at mandating insurers cover OTC birth control

01 April 2024- Governor Josh Shapiro has now urged health insurers in Pennsylvania to make contraception more accessible and affordable, announcing new guidance on insurance coverage that may save women nearly $250 a year for over-the-counter (OTC) contraception.

With the launch of the first ever FDA approved OTC daily birth control pill, Opill, Pennsylvania insurers are strongly encouraged to cover OTC contraceptives with or without a prescription, and are being asked to exempt this medication from the lengthy drug exceptions process as a best practice.

“For millions of women, birth control represents personal freedom and the ability to make choices over their own bodies. Now it’s time that insurance companies step up – I believe no one should be denied access to birth control because they can’t afford it,” said Governor Josh Shapiro. “That’s why today, my Administration is issuing guidance to health insurers that it is now best practice for plans to provide coverage for over-the-counter contraception with or without a prescription. If insurers don’t cover over the counter contraception, our Administration’ will ask for additional information on why not – and the Department will be pushing back to make sure exception processes aren’t preventing women from obtaining reproductive healthcare, and fully comply with federal law. As your Governor, I’m always going to protect reproductive health and a woman’s right to make decisions over her own body – and we will continue holding folks accountable to defend affordable access to healthcare.”

If an insurer chooses not to cover OTC contraception options, the Pennsylvania Insurance Department (PID) will require them to provide additional information to verify compliance with federal law and regulations, assessing why OTC contraception is not covered by the health care plan.

“PID will be pushing companies to make sure exception processes aren’t preventing women from obtaining reproductive healthcare” said Pennsylvania Insurance Commissioner Michael Humphreys. “The U.S. Congress has identified opportunities for insurers to improve access to contraceptive care. PID, too, has identified that such opportunities exist among Pennsylvania’s health insurance plans. We can do better. The Shapiro Administration is committed to protecting Pennsylvanians’ freedom and ensuring they are empowered with choices in their reproductive health care, and covering OTC contraception as a best practice, as a few of our insurers do today, is a nation-leading step forward.”

The FDA recently approved the Opill (norgestrel) tablet for nonprescription use to prevent pregnancy, providing an option for Pennsylvanians to purchase this medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The medication currently costs around $20 for a one-month supply.

Governor Shapiro has always fought for a woman’s right to choose – including launching a website for reproductive health care resources to help Pennsylvanians find information about both medication abortions and in-clinic procedure abortions. Governor Shapiro has been committed to defending the right of Pennsylvanians to access birth control and reproductive healthcare under the Patient Protection and Affordable Care Act before the U.S. Supreme Court as Attorney General.

Last December, Governor Shapiro, led a letter co-signed by six Governors from the multi-state Reproductive Freedom Alliance to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and notified Department of Labor Acting Secretary Julie Su urging the federal government to take all necessary and available steps to ensure that the first ever FDA approved OTC daily birth control pill is fully covered by insurance, so that no one is denied access to critical reproductive healthcare because they can’t afford it.

Pennsylvanians who have any insurance related questions or have an issue with their insurer or agent may file a complaint with PID by contacting PID’s Consumer Services Bureau, or by calling 1-877-881-6388.