ARIZONA STATE SENATE
Phoenix, Arizona
health care coverage;
contraceptive coverage
Requires health insurance
companies that offer prescription drugs and devices to their members to also
provide equal coverage of Federal Drug Administration (FDA) approved
contraceptive drugs and devices as other drugs on the same level of the
formulary.
Since 1973, states have been
required to cover family planning services for Medicaid beneficiaries. However, a 2000 survey carried out by the
Arizona Family Planning Council found that 62 percent of Arizonans’ health care
plans did not cover contraceptives on an equal basis to other
prescriptions. On December 13, 2000, the
United States Equal Employment Opportunity Commission (EEOC) issued a
commission decision finding merit in two charges of discrimination in the
denial of health insurance coverage for prescription contraceptives. The EEOC found that this denial violated
Title VII of the Civil Rights Act of 1964, as amended by the Pregnancy
Discrimination Act, which prohibits sex discrimination by employers with 15 or
more employees. The EEOC based its
decision on the grounds that the respondents in the charges excluded the cost
of prescription contraceptive drugs – available only to women – from their
employee health plan while covering a number of other preventive drugs, devices
and services.
The FDA has approved five
contraceptive methods: Norplant implants, Depo-Provera, Intrauterine Device
(IUD), diaphragm and contraceptive pill.
In addition to birth control,
contraceptives are medically necessary for a variety of problems that women may
incur including regulating a woman's cycle and endometrial and ovarian
cancer. According to the National
Council of State Legislatures, 19 states have passed legislation requiring
insurers who cover prescription drugs to offer coverage for prescription
contraceptives.
This legislation applies to
subscription insurance contracts, health care service organizations, disability
insurance policies, group disability policies, blanket disability policies and
accountable health plans. Under this
legislation, plans already covering prescription drugs and devices would
include equal cost containment measures for prescription contraceptive drugs
and devices as other drugs on the same level of the formulary. Also, plans that
include coverage for outpatient medical services would include FDA approved
outpatient contraceptive services in that coverage.
The health insurance
purchased by the State on behalf of its employees covers some forms of
prescription contraceptives depending on the employee’s plan coverage. The fiscal impact to the state general fund
for this legislation is not currently discernable.
Provisions
1. Requires insurers that provide coverage for:
a.
prescription
drugs to also provide coverage for FDA approved contraceptives.
b.
outpatient
health care services to also provide coverage for FDA approved prescription
outpatient contraceptive services.
2. Prohibits insurers from imposing cost containment measures for contraceptive drugs that are greater than the cost containment measures for other drugs on the same level of the formulary.
3. Provides for a general effective date.
Amendments
Adopted by Committee
1. Eliminates experimental or investigational contraceptive coverage.
2. Clarifies the definition of outpatient contraceptive services.
3. Specifies the drug formulary as multitiered.
4. Requires health care insurance companies that provide coverage for prescription drugs to provide equal cost containment measures for contraceptive drugs as other drugs on the same level of the formulary.
Senate Action
BI 2/7/02 4-2-0
Prepared by Senate Staff
February 8, 2002