Departments Withdraw Proposed Rule Requiring Coverage of OTC Contraceptives as Preventive Care

January 28, 2025

On January 15, 2025, the DOL, HHS, and IRS (the departments) withdrew proposed rules that would have, among other items, expanded ACA preventive care coverage to include over-the-counter (OTC) contraceptives.

Current regulations require non-grandfathered group health plans to cover contraceptives without cost-sharing if prescribed by a healthcare provider. As explained in our November 5, 2024, Compliance Corner article, under the proposed rules, plans would have been required to cover recommended OTC contraceptive items without requiring a prescription or cost-sharing from participants and to meet related disclosure requirements. The proposed rules also would have required plans to cover certain recommended contraceptive items that are drugs and drug-led combination products without imposing cost-sharing requirements, unless a therapeutic equivalent is covered without cost-sharing.

Additionally, the proposed rules would have required plans that use reasonable medical management techniques for any recommended preventive services to provide an easily accessible, transparent, and expedient exceptions process that allows a participant to receive coverage without cost-sharing for a preventive service in the manner medically necessary for them, as determined by their attending provider.

The comment period on the proposed rules closed on December 27, 2024, and the departments received 268 comments to review on a range of issues, including operational and cost issues related to the contraceptive coverage proposals. However, the departments chose to withdraw the proposed rules, citing the need to focus on other matters but noting they may propose new and similar rules in the future.

Plan sponsors do not need to take any action but should be aware of the withdrawal of the proposed rules.

Withdrawal of notice of proposed rulemaking:
Enhancing Coverage of Preventive Services under the ACA