The Institute of Medicine (IOM) on July 19 released a broad set of eight recommendations for strengthening preventive health care services that have the potential to greatly improve women’s health. If the U.S. Department of Health and Human Services (DHHS) endorses these recommendations, private insurance plans would be required to cover the recommended services—including all contraceptive services and supplies approved by the Food and Drug Administration — without cost-sharing (out-of-pocket costs such as deductibles and copays).
The IOM’s recommendations are intended to fill important gaps in three existing sets of services that are already covered without cost-sharing under a provision of the 2010 health reform legislation. Developed after an exhaustive review of the scientific evidence, the recommendations include coverage for an annual well-woman preventive care visit, specific services for pregnant women and nursing mothers, counseling and screening for HIV and domestic violence, as well as services for the early detection of reproductive cancers and sexually transmitted infections.
Significantly, the IOM recommendations also include the “full range of Food and Drug Administration–approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.” The IOM considers these services essential so that “women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes.”
Government bodies and private-sector experts have long recognized contraceptive services as a vital and effective component of preventive and public health care. A strong body of research shows that contraceptive use helps women avoid unintended pregnancy and improve birthspacing, resulting in substantial benefits for the health and well-being of infants, women, families and society.
Making contraceptive counseling, services and supplies—including long-acting, reversible methods (the IUD and the implant), which have high up-front costs—more affordable acknowledges the reality that cost can be a daunting barrier to effective contraceptive use. The evidence strongly suggests that insurance coverage of contraceptive services and supplies without cost-sharing is a low-cost—or even cost-saving—means of helping women overcome this obstacle.
It is now up to DHHS to review the IOM’s recommendations and determine whether they should be adopted. Given that the new guidelines would not go into effect until a full year after DHHS has made a decision, the new recommendations would likely not be written into many insurance plans before 2013 (since insurance plans would not be updated midyear). That would make January 2013 the earliest point that large numbers of women would benefit from the significant improvement in preventive health services available to them.
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