In a letter sent Aug. 9(2 page PDF) to FDA and CMS leaders, the AAFP encouraged the agencies to "endorse and implement policies and coverage decisions that allow adolescents, regardless of age, to be included in the over-the-counter (OTC) oral contraceptives studies required by the FDA."
"Including (adolescents) in such studies would help determine whether OTC access is appropriate for this population," said the letter, which was signed by AAFP Board Chair Wanda Filer, M.D., M.B.A., of York, Pa.
The Academy also asked the agencies to review and revise, as necessary, their "consideration and coverage of contraceptive options to include coverage of all FDA-approved contraceptive options for men and women of reproductive age enrolled in Medicare and Medicaid."
"The AAFP believes there are benefits to having access to all FDA-approved contraceptive options for those who wish to use them," the letter said.
These requests stemmed from a pair of a resolutions adopted by the AAFP's 2016 Congress of Delegates. The first measure asked the Academy to write a letter supporting access to OTC oral contraceptive medication regardless of age. The other resolution originally called for the AAFP to advocate for coverage of emergency contraception -- OTC or prescription -- under all Medicaid programs for women of reproductive age and was sunsequently expanded to include Medicare and men.
OTC Oral Contraceptives Policy
The AAFP's policy on OTC oral contraceptives "supports over-the-counter access to oral contraception without a prescription. Under the Patient Protection and Affordable Care Act, private insurance must cover all contraceptive methods approved by the FDA. The AAFP supports insurance coverage of oral contraceptives regardless of prescription status in all insurance plans."
The policy notes that unintended pregnancies account for about half of U.S. pregnancies, and that access and cost are common reasons why women don't use contraception.
"While oral contraceptive pills are widely considered to be safe and effective medications, they continue to require a prescription for use, further restricting access," the policy says. "The AAFP recognizes that though contraindications to these medications do exist, women have been shown to correctly self-identify contraindications to use when using a standardized checklist."
Medicare, Medicaid Coverage of Contraceptives
The AAFP's letter referenced related Academy policies, such as those that support Medicare coverage for all FDA-approved methods of contraception and those that support adequate payment for reversible contraception methods, including long-acting reversible contraceptives.
"Many men and women insured through public programs, like Medicare and Medicaid, do not benefit from the same comprehensive contraceptive coverage as those with private health insurance without cost-sharing," the letter said. "Hence, these men and women are vulnerable to gaps in contraceptive coverage and/or shouldering higher out-of-pocket costs for birth control."
The letter said because affordable access to FDA-approved contraception options still isn't available to all men and women in the country, the FDA and CMS should expand coverage to everyone enrolled in Medicare and Medicaid.
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