(a)For purposes of this section:
(1)“FDA” means the Food and Drug Administration.
(2)“Therapeutic equivalent” means a contraceptive drug, device, or product that meets all of the following:
a. Approved as safe and effective.
b. Pharmaceutically equivalent to another contraceptive drug, device or product in that it contains an identical amount of the same active drug ingredient in the same dosage form and route of administration and meets compendial or other applicable standards of strength, quality, purity, and identity.
c. Assigned, by the FDA, the same therapeutic equivalence code as another contraceptive drug, device, or product.
(b)Carriers shall provide coverage for contraceptive methods in all health benefit plans delivered or issued for delivery under § 505(3) of this titl
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(a) For purposes of this section:
(1) “FDA” means the Food and Drug Administration.
(2) “Therapeutic equivalent” means a contraceptive drug, device, or product that meets all of the following:
a. Approved as safe and effective.
b. Pharmaceutically equivalent to another contraceptive drug, device or product in that it contains an identical amount of the same active drug ingredient in the same dosage form and route of administration and meets compendial or other applicable standards of strength, quality, purity, and identity.
c. Assigned, by the FDA, the same therapeutic equivalence code as another contraceptive drug, device, or product.
(b) Carriers shall provide coverage for contraceptive methods in all health benefit plans delivered or issued for delivery under § 505(3) of this title. Coverage for contraceptive methods must include all of the following:
(1) All FDA-approved contraceptive drugs, devices, and other products as follows:
a. If the FDA has approved 1 or more therapeutic equivalents of a contraceptive drug, device, or product, a carrier is not required to include all such therapeutically equivalent versions in its formulary as long as at least 1 is included and covered without cost-sharing and in accordance with this section.
b. If there is a therapeutic equivalent of a drug, device, or other product for an FDA-approved contraceptive method, the carrier may provide coverage for more than 1 drug, device, or other product and may impose cost-sharing requirements as long as at least 1 drug, device, or other product for that method is available without cost-sharing. If, however, an individual’s attending provider recommends a particular FDA-approved contraceptive based on a medical determination with respect to that individual, regardless of whether the contraceptive has a therapeutic equivalent, the carrier shall provide coverage for the prescribed contraceptive drug, device, or product without cost-sharing.
c. The carrier is not required to provide coverage for male condoms.
(2) FDA-approved emergency contraception available over-the-counter, whether with a prescription or dispensed consistent with the requirements of Chapter 25 of Title 24.
(3) A prescription for contraceptives intended to last for no more than a 12-month period which may be dispensed all at once or over the course of the 12-month period, regardless of whether the covered individual was enrolled in a plan or policy under § 505(3) of this title at the time the prescription contraceptive was first dispensed.
(4) Voluntary female sterilization procedures.
(5) Patient education and counseling on contraception.
(6) Follow-up services related to the drugs, devices, products, and procedures covered under this subsection, including management of side effects, counseling for continued adherence, and device insertion and removal.
(7) Immediate postpartum insertion of long-acting reversible contraception.
(c) A carrier may not impose any deductible, coinsurance, copayment, or any other cost-sharing requirement for coverage provided under this section, except under paragraph (b)(1) of this section or as otherwise required under federal law. A carrier may not impose unreasonable restrictions or delays in the coverage under this section, except that reasonable medical management techniques may be applied to coverage within a method category, as defined by the FDA, but not across types of methods.
(d) This section does not preclude coverage for contraceptive drugs, devices, products, and procedures as prescribed by a provider for reasons other than contraceptive purposes, including decreasing the risk of ovarian cancer, eliminating symptoms of menopause, or providing contraception that is necessary to preserve the life or health of the covered individual.
(e) Carriers are not required under this section to cover experimental or investigational treatments.