New Preventive Care Requirements for PY 2013

Two weeks ago, I noted that a preventive services task force was considering additions to the preventive services requirements, including prescription contraceptives, breastfeeding support and equipment and domestic violence counseling.  This morning HHS approved the recommendations of the Health Resources and Services Administration.  The press release from HHS is appended below. In summary, the new requirements include the following:

Well-woman visits (at least annually)

Screening for gestational diabetes

Human papillomavirus (HPV) DNA testing for women 30 years and older

Screening and counseling for sexually-transmitted infections

FDA-approved contraception methods and contraceptive counseling

Breastfeeding support, supplies, and counseling

Domestic violence screening and counseling.

Non-grandfathered health plans must provide the above additional services at no cost beginning with plan years commencing on or after August 1, 2012 (one year after the recommendation was issued). This means that the new guidelines will apply to calendar year plans beginning January 1, 2013.

One of the most controversial requirements is the requirement to provide all FDA-approved contraceptive methods, including prescription drugs, at no cost. Based on the HHS release, if a generic drug is available, the generic drug must be provided at no cost, but cost-sharing can be charged for branded drugs. If all that is available is a branded drug, the branded drug will need to be provided at no cost under the new requirements.

http://www.hhs.gov/news/press/2011pres/08/20110801b.html

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