Oral contraceptive

Oral contraceptive refers to a prescription medication classified as a hormonal birth control method taken by mouth to prevent pregnancy. Insurance policies, including Medicaid and ACA-compliant health plans, typically cover oral contraceptives with zero out-of-pocket cost since 2012 under the Affordable Care Act mandate.

Generic versions of oral contraceptives, such as levonorgestrel-ethinyl estradiol brands (e.g. Sprintec), are generally covered by most insurers with no copay required.

Insurers may require prior authorization for brand-name oral contraceptives like Yaz or Loestrin based on formularies. Some insurance providers limit coverage of extended-cycle oral contraceptives (e.g.

Seasonique) unless medically necessary documentation is provided. Over-the-counter emergency oral contraceptives (e.g.

Plan B One-Step) are only covered by insurance with a prescription in several states. Dependent minors’ confidentiality regarding oral contraceptive coverage varies by state law and insurer privacy practices.

Mail-order pharmacy benefits often include 90-day supplies of covered oral contraceptives at reduced copays compared to monthly retail refills. Flexible spending accounts and health savings accounts reimburse out-of-pocket costs for non-covered or over-the-counter oral contraceptives with proper receipts, based on a report from YourInsurance.info (Your Insurance Info).

Coverage exclusions may apply if an employer uses a religious exemption, affecting access to prescribed oral contraceptives through that group health plan.