Biden administration proposes free over-the-counter birth control
The proposal would expand free coverage under the Affordable Care Act to include birth control pills, emergency contraceptives and condoms.
The White House on Monday plans to propose broadening access to free birth control for people covered by private health insurance plans — a bid that surfaces one of Democrats’ most popular issues two weeks before the election.
The proposed rule would mandate that health plans cover over-the-counter birth control — including daily pills, emergency contraceptives and condoms.
The announcement comes as Vice President Kamala Harris has made reproductive rights a centerpiece of her campaign for the White House, and Democrats are banking on the issue to help the party not only defeat former president Donald Trump but maintain control of the Senate and recapture the House. This November marks the first presidential election since the Supreme Court overturned the constitutional right to abortion in June 2022, fueling a seismic shift in the nation’s reproductive health landscape.
“While we fight to protect and expand health care, extremist so-called leaders are attacking reproductive freedom at every turn,” Harris said in a statement. “Republicans in Congress have repeatedly blocked legislation to protect the right to contraception across the country.”
The Biden administration’s plan would also expand the choice of free birth control, in response to complaints that people seeking a specific kind of birth control often face significant costs since insurers are currently required to cover only one drug within each category of contraception. Under the proposal, insurers would have to cover all approved drugs, unless they have a therapeutic equivalent that is covered, which would lead to more brands of birth control pills and a wider selection of IUDs being available free.
Kristine Lucius, domestic policy adviser to Harris, touted the proposal as “the most significant expansion of contraception coverage under the Affordable Care Act in more than a decade.”
The Affordable Care Act mandates insurance companies cover contraception at no cost, but plans are not required to cover items available over the counter unless the patient has a prescription. Prominent congressional Democrats and reproductive rights advocates have been urging the Biden administration to change the rules.
Reproductive health advocates have said that making contraception easily available is more important than ever in a post-Roe America where most abortions are banned in more than a dozen states. Since the Supreme Court’s ruling, far-right conservatives have been attempting to curtail access to some forms of birth control by sowing misinformation about how various methods work, even as GOP leaders scramble to reassure voters they have no intention of restricting contraception.
If finalized, the rule would expand access for 52 million women of reproductive age covered by private health plans, according to the Biden administration.
“We believe that women in every state must have the freedom to make deeply personal health care decisions, including the right to decide if and when to start or grow their family,” Biden said in a statement.
Health plans could choose different ways to administer the proposal, with more details to come in a final rule, administration officials said. Some consumers may be able to get free birth control by picking up the product in store aisles and bringing it to the pharmacy counter to check out; others could obtain the medication by bringing it to the front of the store. Officials did not rule out the possibility of some consumers buying the products, then seeking reimbursement from their health plan.
It will be a tough lift to finalize the proposal before a new president assumes office in late January. The proposal must undergo a 60-day comment period, and it often takes months to years for federal agencies to respond to comments on a rule and release a final plan. But a key administration official insists finalizing the rule in the coming months would be possible.
“We will work quickly to conclude it before the end of this administration,” Jennifer Klein, the director of the White House Gender Policy Council, said in an interview. “The urgency is clear.”
In July 2023, the Food and Drug Administration approved the first over-the-counter birth control pill in the United States — which marked a milestone in the decades-long quest to make oral contraceptives easier to obtain. The move to greenlight Opill, manufactured by Perrigo, came more than six decades after birth control pills were introduced in the United States.
Opill first became available in stores and online this spring. The suggested retail price is $19.99 for a one-month supply and $49.99 for a three-month pack. But many insurers have not been required to cover the pill without a prescription, raising concerns that the medication may be out of reach for those who could most benefit. Some states require insurers to cover over-the-counter birth control without a prescription, according to KFF.
“The FDA’s approval of Opill is a milestone,” a group of 48 Senate Democrats wrote in a letter to top White House officials last year. “However, for an OTC birth control pill to meet its potential and be truly accessible, federal departments must ensure that it is covered without cost-sharing and without the need for a prescription as a condition of coverage.”
Separately, repeated investigations have shown that some health plans are flouting the law and requiring patients to pay for birth control that should be free under the Affordable Care Act — prompting frustration from Democrats on Capitol Hill. The Biden administration has taken other steps intended to shore up no-cost contraception, such as sending a letter to health insurers in January reminding them of their obligations under the law.
“We have heard from women who need a specific brand of birth control, but the cost of their prescription isn’t covered by their health insurance,” Xavier Becerra, secretary of the Department of Health and Human Services, told reporters on a call Friday. “We have made clear that in all 50 states, the Affordable Care Act guarantees coverage of women’s preventive services without cost sharing, including all birth control methods approved by the Food and Drug Administration.”
