Coverage change for contraceptives and contraceptive supplies effective January 1, 2019
Coverage changes for contraceptives and related contraceptive supplies became effective January 1, 2019, due to recent mandates in Connecticut, Maine and New Hampshire.
The mandates in all three states require coverage of up to a 12-month supply of certain contraceptive drugs, devices or products with no out-of-pocket cost to the member. These include FDA-approved contraceptives, devices or products. In some cases, a prior authorization may be required if a member opts for a non-formulary drug that has a therapeutic equivalent on our drug lists.
The member can obtain the 12-month supply all at once or throughout the benefit year, at the prescribing physician’s discretion.
What’s the exception to these benefit requirements?
The only exception to these requirements is that a member will be charged for the cost of these drugs, devices or products, even if covered by the ACA, if they obtain them at an out-of-network pharmacy.
February 2019 Anthem Maine Provider Newsletter