On February 1, the Obama administration announced a proposed rule to cover women’s preventive services with no cost sharing under the Affordable Care Act (ACA), while working around the objections of many religious organizations to contraceptive services.
The workaround would affect pharmacists who will have to process these claims and explain the topic to patients, as well as pharmacists and student pharmacists who receive health insurance coverage through nonprofit religious organizations such as some universities or hospitals.
“Pharmacists should be aware that there are more options for benefits coverage … as they process outpatient claims,” said Marcie Bough, PharmD, APhA Senior Director of Government Affairs. If the proposal is finalized, pharmacists could tell patients what information they should have received from their health plan.
Under the proposed rule, issued by the Treasury, Labor, and Health & Human Services (HHS) Departments, nonprofit religious organizations can receive an accommodation that provides separate contraceptive coverage at no cost to women enrollees and at no cost to the religious organization.
Religious organizations with health insurers, including for student health plans, would notify their insurer; the insurer would then notify enrollees that they would have contraceptive coverage, at no cost, through separate individual health insurance policies.
And religious organizations that are self-insured would notify their third-party administrator; the third-party administrator would work with an insurer to arrange contraceptive coverage, at no cost, through separate individual health insurance policies.
The proposed rule simplifies the definition of religious employer for purposes of the exemption by eliminating criteria that a religious employer have the inculcation of religious values as its purpose, primarily employ people who share its religious tenets, and primarily serve people who share its religious tenets.
Private businesses are not included in the accommodation for nonprofit religious employers under the proposed rule.
ACA requires health insurance companies to provide free preventive services to women (with new or renewed insurance plans since August 2012). FDA-approved contraceptive methods and contraceptive education and counseling are just one of the eight services that now have no cost sharing. These preventive services for women were recommended by the Institute of Medicine to HHS in July 2011.
Since the Obama administration announced its policy and then revised its policy on no-cost contraceptive coverage a year ago, some religious groups have objected. Lawsuits followed.