About Contraceptive Equity
“Contraceptive Equity” means that every person can make their own decisions about pregnancy prevention, and contraceptive care is easily accessible and covered at no cost in all health programs. It requires acknowledging the critical role that family planning plays in improving health outcomes and economic security for people of reproductive age and their families, and simultaneously grappling with this country’s history of reproductive coercion. Further, Contraceptive Equity demands that we proactively address the historically inadequate coverage of comprehensive birth control services using a reproductive justice lens. While many states have Contraceptive Parity laws, requiring coverage of contraceptives in the same manner as other prescription drugs, and the Affordable Care Act (ACA) creates federal requirements for contraceptive coverage, Contraceptive Equity remains elusive.
The National Health Law Program’s Model Contraceptive Equity Act (Model Act), which we created after co-sponsoring Contraceptive Equity legislation in California in 2014, goes beyond existing federal standards. The Model Act prevents insurers from erecting service barriers via medical management techniques, like cost-sharing, prior authorization, prescription requirements, gender restrictions, or quantity limitations. Versions of our legislation have been introduced in 40 jurisdictions and enacted in 14 states and Washington, D.C. This type of law is crucial to maintaining and expanding access to reproductive and sexual health care moving forward.
Resources on Contraceptive Equity
Issue Briefs
- Contraceptive Equity in Action: A Toolkit for State Implementation
- Model Contraceptive Equity Act: Legislative Language and Issue Brief
Fact Sheets
- Fact Sheet: Coverage of Over-the-Counter Drugs in Medicaid
- Fact Sheet: State Contraceptive Equity Laws
- Health Advocate: States Expand Coverage of Contraception
- Lessons from CA: Contraceptive Coverage
Blogs
- New Tools Support States Putting Contraceptive Equity into Action
- In Face of Hostile Trump Administration, Washington State Takes Action to Protect and Expand Access to Reproductive Health Care
- States Like Oregon Act to Ensure Access to Reproductive Care
Press Releases
State Contraceptive Equity Legislation & Statutes
The National Health Law Program is currently tracking state legislation relating to Medicaid and private insurance coverage of contraceptive care. We have compiled our analysis of enacted Contraceptive Equity laws into the chart below, which we hope will be a helpful resource for providers, advocates, researchers, legislators, third-party payers, and other stakeholders working on this issue. We are doing our best to update this chart on a regular basis. If you have any corrections, comments, or questions about this chart, please contact NHeLP Staff Attorney Liz McCaman at mccaman@healthlaw.org.
| STATE | BILL NUMBER | TITLE OF BILL | DESCRIPTION | OPERATIVE DATE | STATUTORY CITATION | LAST UPDATED |
|---|---|---|---|---|---|---|
| California | SB 1053 | Health care coverage: contraceptives (Contraceptive Coverage Equity Act) | • Coverage of all FDA-approved contraceptive drugs, devices, and products in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered). • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) in private insurance and Medicaid managed care. | 1/1/16 | Cal. Health & Safety Code § 1367.25, Cal. Ins. Code § 10123.196, Cal. Welf. & Inst. Code § 14132 | 6/27/19 |
| California | SB 999 | Health care coverage: contraceptives: annual supply | • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and Medicaid managed care. | 1/1/17 | Cal. Health & Safety Code § 1367.25, Cal. Bus. & Prof. Code § 4064.5, Cal. Ins. Code § 10123.196 | 6/27/19 |
| Connecticut | HB 5210 | An Act Mandating Insurance Coverage of Essential Health Benefits and Expanding Mandated Health Benefits for Women, Children and Adolescents | • Coverage of all FDA-approved contraceptive drugs, devices, and products in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (allows for step therapy with generics first). • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance. • Coverage of OTC contraceptive drugs (levonogestrel EC, spermicide, sponge w/spermicide) in private insurance; prescription requirements are not explicit. | 1/1/19 | Conn. Gen. Stat. §§ 38a-503e, 38a-530e | 6/27/19 |
| Delaware | SB 1053 | An Act to Amend Title 18, Title 29, and Title 31 of the Delaware Code Relating to Insurance Coverage of Contraceptives | • Coverage requirements in private insurance and Medicaid managed care for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and Medicaid managed care. • Coverage of OTC emergency contraception without a prescription in private insurance and Medicaid managed care. | 7/11/18 | Del. Code Ann. tit. 18, §§ 3342A, 3559, tit. 29, § 5203A, tit. 31 § 526 | 6/27/19 |
| District of Columbia | B21-0020 | Access to Contraceptives Amendment Act | • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and Medicaid managed care. | 1/1/17 | DC Code § 31-3834.01 | 6/27/19 |
| District of Columbia | B22-0106 | Defending Access to Women’s Health Care Services Amendment Act | • Coverage of all FDA-approved contraceptive drugs, devices, and products in private insurance and Medicaid managed care, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered; allows for step therapy with generics first). • Coverage requirements in private insurance and Medicaid managed care for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of OTC contraceptive drugs and devices (levonogestrel EC, spermicide, sponge w/spermicide, male condom, internal/female condom) in private insurance and Medicaid managed care; prescription requirements are unclear. • Adds OTC contraceptives and those obtained directly from a pharmacist as elible for a 12 months' supply; prescription requirements for OTC contraceptives are not explicitly included. | 1/1/19 | DC Code §§ 31-3834.01–.03 | 6/27/19 |
| Illinois | HB 5576 | Contraceptive Coverage Act | • Coverage of all FDA-approved contraceptive drugs, devices, and products in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered). • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) in private insurance. • Coverage requirements in private insurance for male vasectomy. • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of certain OTC contraceptive drugs and devices (levonogestrel EC, spermicide, sponge w/spermicide, internal/female condom) in private insurance; prescription requirements are unclear. • Coverage of a 12 months' supply of contraceptive supplies in private insurance. | 1/1/17 | 215 Ill. Comp. Stat. 5/356z.4 | 6/27/19 |
| Maine | HP 860 - LD 1237 | An Act To Require Insurance Coverage for Contraceptive Supplies | • Coverage in private insurance of one contraceptive supply within each method of contraception that is identified by the FDA (implicitly including male condoms; prescription requirements are implied but not explicit). • Coverage of a 12 months' supply of contraceptive supplies in private insurance. | 1/1/19 | Me. Rev. Stat. Ann. tit. 24-A, §§ 2756, 2847, 4247 | 6/27/19 |
| Maryland | SB 848 | Contraceptive Equity Act | • Coverage of all FDA-approved contraceptive drugs and devices in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered). • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) on LARCs in private insurance, Medicaid managed care, and CHIP. • Coverage requirements in private insurance for male vasectomy and male condom with a prescription. • Coverage of OTC contraceptive drugs (levonogestrel EC, spermicide, sponge w/spermicide) in private insurance; cost-sharing without a prescription at in-network pharmacies may not exceed that required for that same drug dispensed under a prescription. • Coverage of a 6 months' supply of prescription contraceptive supplies in private insurance, Medicaid managed care, and CHIP. | 1/1/18 | Md. Code Ann., Ins. §§ 15–826.1, 826.2, 831, Health–Gen. § 15-148 | 6/27/19 |
| Maryland | SB 774/HB 994 | Maryland Medical Assistance Program - Family Planning Services | • Coverage of a 12 months' supply of prescription contraceptive supplies in Medicaid managed care and CHIP. | 7/1/18 | Md. Code Ann., Health–Gen. § 15-148 | 6/27/19 |
| Maryland | SB 986/HB 1024 | State Employee and Retiree Health and Welfare Benefits Program - Contraceptive Drugs and Devices and Male Sterilization | • Coverage of all FDA-approved contraceptive drugs and devices for state employees, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered). • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) on LARCs for state employees. • Coverage requirements for state employees for the male condom, with a prescription requirement. • Coverage of OTC contraceptive drugs (levonogestrel EC, spermicide, sponge w/spermicide) for state employees; cost-sharing without a prescription at in-network pharmacies may not exceed that required for that same drug dispensed under a prescription. • Coverage of a 6 months' supply of prescription contraceptive supplies for state employees. | 10/1/18 | Md. Code Ann., Ins. § 15–826, State Pers. & Pens. § 2–503 | 6/27/19 |
| Maryland | HB 1283 | Health Insurance - Prescription Contraceptives - Coverage for Single Dispensing | • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and for state employees (by reference). | 1/1/20 | Md. Code Ann., Ins. § 15–826.1 | 6/27/19 |
| Massachusetts | HB 4009 | An Act relative to advancing contraceptive coverage and economic security in our state (The ACCESS Act) | • Coverage of all FDA-approved contraceptive drugs and devices in private insurance and Medicaid managed care and for state employees, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (coverage of drugs without a therapeutic equivalent is not required). • Coverage requirements, in private insurance, Medicaid managed care, and for state employees, for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of OTC levonogestrel EC without a prescription in private insurance, Medicaid managed care, and for state employees. • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance, Medicaid managed care, and for state employees. | 5/20/18 | Mass. Gen. Laws ch. 32A, § 28, ch. 118E, § 10J, ch. 175, § 47W, ch. 176A, § 8W, ch. 176B, § 4W, ch. 176G, § 4O | 6/27/19 |
| Nevada | SB 233 | An Act relating to health care; requiring the State Plan for Medicaid and certain health insurance plans to provide certain benefits relating to reproductive health care, hormone replacement therapy and preventative health care; revising provisions relating to dispensing of contraceptives; and providing other matters properly relating thereto. | • Coverage requirements in private insurance and Medicaid managed care for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of certain OTC contraceptive drugs and devices (levonogestrel EC, spermicide, sponge w/spermicide, internal/female condom) in private insurance; prescription requirements are unclear but implied. • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and Medicaid managed care. | 1/1/18 | Nev. Rev. Stat. §§ 422.27172, 639.28075, 689A.0418, 689B.0378, 689C.1676, 695A.1865, 695B.1919, 695C.1696, 695G.1715 | 6/27/19 |
| New Hampshire | SB 421 | Relative to insurance coverage for prescription contraceptives | • Coverage requirements in private insurance and Medicaid managed care for the male condom with a prescription. • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and Medicaid managed care. | 1/1/19 | N.H. Rev. Stat. Ann. §§ 415:6-w, 415:18-i, 420-A:17-c | 6/27/19 |
| New Mexico | HB 89 | Health Coverage for Contraception | • Coverage for state employees of a sufficient number and assortment of oral contraceptive pills to reflect the variety approved by the FDA (exception for therapeutic equivalents and brand names without a therapeutic equivalent). • Coverage requirements for state employees for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of a 6 months' supply of prescription contraceptive supplies for state employees, and a 12 month's supply in Medicaid managed care. • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) for state employees. • Coverage requirements for state employees for male vasectomy and the male condom, without a prescription requirement. • Coverage of OTC drugs, items, and services (including sponge w/spermicide, spermicide alone, male condom, internal/female condom, and levonogestrel EC) without a prescription for state employees. | 6/14/19 | N.M. Stat. §§ 13-7, 27-2 | 6/27/19 |
| New Mexico | HB 89 | Health Coverage for Contraception | • Coverage in private insurance of a sufficient number and assortment of oral contraceptive pills to reflect the variety approved by the FDA (exception for therapeutic equivalents and brand names without a therapeutic equivalent). • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of a 6 months' supply of prescription contraceptive supplies in private insurance. • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) in private insurance. • Coverage requirements in private insurance for male vasectomy and the male condom, without a prescription requirement. • Coverage of OTC drugs, items, and services (including sponge w/spermicide, spermicide alone, male condom, internal/female condom, and levonogestrel EC) without a prescription in private insurance. | 1/1/20 | N.M. Stat. §§ 59A-22-42, 59A-46-44, 59A-22, 59A-23, 59A-46, 59A-47 | 6/27/19 |
| New York | S659A, S1507C | Comprehensive Contraception Coverage Act | • Coverage of all FDA-approved contraceptive drugs and devices in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered). • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of a 12 months' supply of contraceptive supplies in private insurance and Medicaid managed care. • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) in private insurance. • Coverage of certain OTC drugs and devices (the sponge w/spermicide, spermicide alone, internal/female condom, and levonogestrel EC) in private insurance; lack of presription requirement is implied but not explicit. | 1/1/20 | N.Y. Ins. Law §§ 3221(I)(16), 4303(cc)(1), 3216(i)(17)(E)(v), N.Y. Soc. Serv. Law § 365-(a)(3)(d) | 6/27/19 |
| Oregon | HB 3343 | Relating to contraceptives | • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance. | 1/1/16 | Or. Rev. Stat. § 743A.066 | 6/27/19 |
| Oregon | HB 3391 | Relating to reproductive health care; and declaring an emergency (Reproductive Health Equity Act) | • Coverage of all FDA-approved contraceptive drugs and devices in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories (exception for therapeutically equivalent products, so long as at least one is covered). • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) in private insurance. • Coverage requirements in private insurance for male vasectomy and the male condom. • Coverage of pharmacy claims for OTC drugs and devices (incl. sponge w/spermicide, spermicide alone, internal/female condom, male condom, and levonogestrel EC) in private insurance; lack of presription requirement is strongly implied but not explicit. | 1/1/19 | Or. Rev. Stat. § 743A.067 | 6/27/19 |
| Vermont | HB 620 | An act relating to health insurance and Medicaid coverage for contraceptives | • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance and Medicaid managed care. • Coverage requirements in private insurance for male vasectomy. | 10/1/16 | Vt. Stat. Ann. tit. 8, § 4099c | 6/27/19 |
| Washington | HB 1234 | Addressing private health plan coverage of contraceptives | • Coverage of a 12 months' supply of prescription contraceptive supplies in private insurance. | 1/1/18 | Wash. Rev. Code § 48.43.195 | 6/27/19 |
| Washington | SB 6219 | Concerning health plan coverage of reproductive health care (Reproductive Parity Act) | • Coverage of all FDA-approved contraceptive drugs and devices in private insurance, beyond the ACA requirement of one covered contraceptive method in each of 18 categories. • Coverage requirements in private insurance for all related contraceptive services including initial and ongoing counseling, device insertion and removal, and management of side effects. • Strictly limits the ability of insurers to impose restrictions and delays (referred to as medical management or utilization controls) in private insurance. • Coverage requirements in private insurance for male vasectomy and the male condom, without a prescription. • Coverage for OTC drugs and devices (incl. sponge w/spermicide, spermicide alone, internal/female condom, male condom, and levonogestrel EC) in private insurance; presription requirement is explicitly prohibited. | 1/1/19 | Wash. Rev. Code § 48.43.072 | 6/27/19 |
