Reminder: Harvard Pilgrim’s Birth Control Coverage

Harvard Pilgrim would like to remind our provider network of our prescription contraceptive coverage, which allows for up to a 12-month supply of birth control medications with no cost-sharing, and to emphasize our focus on responsible prescribing.

As you are likely aware, the 2017 Massachusetts Contraceptive ACCESS Law (Advancing Contraceptive Coverage and Economic Security in our State) requires insurers to cover FDA-approved prescription contraceptives for their members with no cost-sharing for up to a 3-month supply for the first time the prescription contraceptive is dispensed, and for up to a 12-month supply for any subsequent dispensing of the same prescription.

Harvard Pilgrim’s contraceptive coverage for Massachusetts members is consistent with the ACCESS law. The 3-month initial fill requirement is intended to promote responsible prescribing and ensure that the member is stable on the prescription contraceptive and wishes to continue on the medication long term. Because it is not uncommon for patients to switch prescription contraceptives until they find the appropriate fit for them, there is a strong potential for waste resulting from a member picking up a year’s supply of one medication only to switch to a different one along the way.

Harvard Pilgrim also allows up to a 12-month supply of maintenance birth control with no member cost-sharing in Connecticut, Maine, and New Hampshire. While the initial 3-month fill is not required in those states, it is our recommendation that providers practice responsible prescribing whenever possible and only prescribe the amount that is clinically appropriate for a given patient/circumstance.

Prior authorization is not required for the 12-month supply.


Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator