Proposed Rules – Expanding Preventive Contraceptive Coverage for 2026

The agencies released proposed guidance that could go into effect for 2026 plan years if finalized. The proposed rules address expanding OTC contraceptive coverage and reasonable medical management techniques.  A Fact Sheet for the proposed rules can be found here.

A summary of the Proposed Rules can be found below.

• Expanded OTC Contraceptive Coverage – The proposed rules would require non-grandfathered group health plans to cover the following as preventive with no cost-sharing, unless there is a valid religious or moral objection to providing the coverage: 
  • Recommended over-the-counter (OTC) contraceptives without requiring a prescription; and 
  • Certain recommended contraceptive items that are drugs and drug-led combination products, unless at least one therapeutic equivalent of the drug or drug-led combination product (as defined by the FDA) is covered without cost sharing. 

In addition, the proposed rules would require that all price comparison tools (internet-based, self-service tools for comparing the prices of all covered items and services required by the Transparency in Coverage rules) include a disclosure explaining that OTC contraceptive items are covered with no cost-sharing without requiring a prescription along with a phone number and hyperlink to where more information is available about the plan’s contraception coverage. 

• Reasonable Medical Management Techniques – The proposed rule restates previous FAQ guidance indicating that when reasonable medical management techniques are imposed for any preventive care, the plan must provide an easily accessible, transparent, and sufficiently expedient exceptions process that allows an individual to receive coverage without cost-sharing for the preventive service according to the frequency, method, treatment, or setting that is medically necessary for them, as determined by the individual’s provider, even if that service is not generally covered under the plan.

No action is needed at this time. IMA Compliance will be sure to publish any updates.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.

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