Blue Links for Employers

New Massachusetts State Mandate - Contraceptives

On Monday November 20, 2017, Governor Baker signed into law the contraceptive ACCESS bill (An Act advancing contraceptive coverage and economic security in our state).  This bill is effective May 20, 2018, and mandates coverage for the following contraceptive methods and services for females, with no cost sharing:

  • Food and Drug Administration (FDA)-approved contraceptive drugs, devices and other products (excludes male condoms). If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device or product, plans are not required to cover all therapeutically equivalent versions as long as at least one is included and covered without cost sharing.
  • FDA-approved emergency contraception available over-the-counter.
  • Voluntary female sterilization procedures.
  • Patient education and counseling on contraception.
  • Follow-up services related to the drugs, devices, products and procedures listed above including, but not limited to, management of side effects, counseling for continued adherence and device insertion and removal.

Dispensing requirement: The law also stipulates that contraceptives can be dispensed for an initial fill for a 3-month period and then, a 12-month period for any subsequent dispensing of the same prescription which may be dispensed all at once or over the course of the 12-month period, regardless of whether the covered person was enrolled in the policy, contract, or plan at the time the prescription contraceptive was first dispensed

Who does this apply to?

This mandate applies to insured commercial plans, except an employer that is a church or qualified church-controlled organization can be exempt from providing contraceptive coverage upon request. An employer that invokes the exemption due to religious reasons has to provide written notice to prospective employees, prior to enrollment in the plan, listing the contraceptive health care methods and services for which that employer will not provide coverage. However, coverage for these contraceptive drugs, devices, products and procedures must be provided when prescribed by a provider for a reason other than contraceptive purposes, including but not limited to decreasing the risk of ovarian cancer, eliminating symptoms of menopause or necessary to preserve the life or health of the subscriber or the subscriber’s spouse or covered dependents.

How does this apply to your health plan?

Since all non-grandfathered plans (self-insured and fully-insured) are currently required by the Affordable Care Act (ACA) to provide coverage for FDA-approved contraceptive drugs, devices and products with no cost sharing, no changes are required to comply with this requirement.

Grandfathered fully-insured plans that are not a church or church-controlled employer, will need to update their contraceptive services coverage to comply with the state law and provide coverage with no cost sharing on anniversary or after May 20, 2018.

Plans will also be updated to include the dispensing requirement for all fully insured plans.

For additional details or any questions, please contact your account executive.

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