Feds Asking for Input on Coverage of Key Preventive Services

CMS is specifically looking into requiring most health insurance plans to cover OTC contraceptives, tobacco smoking cessation products, and breastfeeding supplies.

Officials from three departments of the federal government are seeking public input on how to ensure coverage of some of the most prevalent over-the-counter (OTC) preventive services in the country – including the possibility of requiring most health insurance plans to cover them with no cost and without a prescription.

The announcement came in the form of a Centers for Medicare & Medicaid Services (CMS) press release issued this week, citing input from the departments of Health and Human Services (HHS), Labor, and the Treasury. Their Request for Information (RFI) specifically solicits comment on access to OTC items such as contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies.

“Under the Affordable Care Act, most plans and issuers must cover certain recommended preventive items and services at no cost. Several of these recommended preventive items and services are currently available to consumers OTC without a prescription, but are not required to be covered without cost-sharing unless prescribed by a healthcare provider,” the press release read. “The goal of the RFI is to understand the potential challenges and benefits for various interested parties, including consumers, plans, issuers, pharmacies, and healthcare providers, to provide coverage at no cost for recommended OTC preventive products without requiring a prescription.”

Officials added that experts in the field of medicine have recommended the products as meriting consideration of coverage at no cost and without a prescription.

“All Americans deserve access to quality healthcare. We know that making preventive care available over the counter can improve access – but there may still be cost barriers. That’s why we are working with the Department of Labor and Department of the Treasury to better understand how a policy change that could further increase access to affordable, preventive care might affect consumers, pharmacies, and health insurance providers,” HHS Secretary Xavier Becerra said in a statement. “I hope everyone who might be impacted will submit their comments and help us advance equity in access to high-quality preventive care like contraception and tobacco cessation.”

“CMS remains steadfast in its commitment to advancing health equity. Easing financial barriers to preventive healthcare items, without a prescription, is one way to help achieve this goal,” CMS Administrator Chiquita Brooks-LaSure added. “Public input on this change to current policy is vital, and we look forward to hearing from consumers, plans, issuers, and providers about its potential impact.”

Officials added that the announcement aligns with President Biden’s executive orders on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services (June 23, 2023), Strengthening Medicaid and the Affordable Care Act (January 28, 2021), and Continuing To Strengthen Americans’ Access to Affordable, Quality Health Coverage (April 25, 2022).

There will be a 60-day comment period. For more information on how to submit comments or to review the entire rule, visit the Federal Register https://www.federalregister.gov/public-inspection/current.

The RFI submitted to the OFR is also available at:  https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/cms-9891-nc.pdf

Contraception was named one of 10 most important public health achievements of the 20^th century by the Centers for Disease Control and Prevention (CDC). A total of about 99 percent of U.S. women who have been sexually active report having used some form of contraception, and 87.5 percent report use of a highly effective and reversible method, according to the American College of Obstetricians and Gynecologists (ACOG). Still, nearly half of American pregnancies are unintended.

Cigarette smoking remains the leading cause of preventable disease and death in the U.S., killing nearly half a million Americans annually, according to the CDC. Smoking cost the U.S. $600 billion in 2018, but progress has been made since the turn of the century – nearly 21 percent of Americans reported smoking cigarettes in 2005, and that figure was cut nearly in half by 2021, when 11.5 percent reported cigarette use.  

According to the most recent CDC Breastfeeding Report Card, among infants born in 2019, more than 4 in 5 started out receiving at least some breast milk.