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White House seeking input on contraceptive drug coverage mandate

Posted On: Mar. 19, 2012 12:00 AM CST

WASHINGTON—Stepping once again into the controversial area of mandated prescription contraceptive drug coverage, the Obama administration last week asked for comments on a range of ways nonprofit affiliates of religious organizations could comply with the mandate.

Under final regulations, full coverage—with no copayments or other cost-sharing requirements—will have to be offered by group health care plans for plan years starting on or after Aug. 1, 2012.

In the case of nonprofit affiliates of religious organizations, such as universities and health care systems, the regulation requires that affiliates' health insurers offer the coverage at no cost. That part of the regulation would apply for plan years starting on or after Aug. 1, 2013.

At the time the administration unveiled the coverage rules for nonprofit affiliates of religious organizations, the administration said it later would develop requirements for nonprofit affiliates that self-fund their health care benefit plans.

In developing those rules, the administration said Friday in an “advance notice of proposed rulemaking,” it would like public comments on some proposals it is considering.

Under one idea the administration is floating, the affiliates' third-party administrators could fund the coverage through rebates they receive from drug manufacturers that the TPA is not contractually liable to forward to the affiliates.

Additionally, the administration noted that nothing would prevent a TPA from receiving funds from a private, nonprofit organization to pay for contraceptives. But it isn't clear why an outside organization would want to do this, experts say.

Under yet another administration idea, TPAs that, starting in 2014, will be required to help pay for a special health care reform law reinsurance program, could receive credits against reinsurance assessments for any payment they make for prescription contraceptives provided to those enrolled in the affiliates' self-funded plans.

In addition, the administration says it would welcome other ideas on how the coverage could be funded. One idea, which the administration says has been suggested by “religious stakeholders,” would be the use of tax-preferred accounts—presumably such as health savings accounts—to fund the coverage.

While not spelled out in detail, the employer would make contributions to the accounts that “employees may in their discretion use for a range of medical services that neither precludes nor obligates funds to be used for contraceptive services,” the administration said.

None of the proposals are very attractive, noted Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.

“The administration might be more costly than the actual costs of the prescriptions,” he said.