The ACA and OTC Medications – What Physicians Need to Know About Changes in Coverage

January 1 has come and gone, but many of us are unaware of some of the changes with the Affordable Care Act, particularly related to coverage of medications and supplements that became effective in 2014. For our patients who are enrolled in ACA-compliant plans, certain over-the-counter (OTC) medications are now covered at no cost when written as a prescription. Translation: Write prescriptions for these medications when medically necessary.

As an example, aspirin is now a covered medication under the ACA for women ages 55–79 when the benefit of reducing heart attacks outweighs the risk of gastrointestinal bleeding. The cost of OTC emergency contraception is also covered if a prescription is written for it. Vitamin D supplements are covered for women ages 65 and older to prevent fractures. And folic acid supplements are covered for women capable of becoming pregnant.

This change in insurance coverage comes at a time when research is looking closely at the benefits of supplements. Certainly all of us are confused at times when related research appears in the media and the benefits of vitamins and supplements are questioned. That’s why we as physicians need to make recommendations to our patients based on their individual needs. This ensures that reproductive-age women don’t forgo important and proven supplements—for instance, folic acid to reduce birth defects like spina bifida—based on a single study.

As physicians, we are in a position to not only recommend, but to reinforce the use of these medications and vitamin supplements for preventive health. It’s up to us health care providers to recommend and prescribe them.

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Wrong-Headed Decision on Plan B One-Step

For a decade, ACOG has supported making emergency contraception (EC) available over the counter (OTC) without an age restriction. So it was deeply troubling and disappointing to see HHS Secretary Kathleen Sebelius overrule the US Food and Drug Administration’s decision to remove the age restriction and make Plan B® One-Step accessible to all females capable of becoming pregnant.

The argument that 11- and 12-year-olds are not capable of understanding how to use EC isn’t true, based on the data, and it misses the point. The majority of girls this young are not sexually active and do not represent the bulk of adolescents who are at risk of an unwanted pregnancy. According to the Guttmacher Institute, nearly half of all high school students in the US have had sex at least once, and 85% of adolescent pregnancies are unintended. These high school students are the adolescents who would most benefit from OTC access to EC.

The overwhelming scientific evidence shows that EC is safe for teens and women and is highly effective in preventing unintended pregnancy. Ideally, all sexually active teens and women would use effective contraception each and every time they engaged in sexual intercourse to avoid an unplanned pregnancy. But, we don’t live in a perfect world—a condom tears or you miss a pill, for instance. Rapid access to EC is especially important for women that have been raped.

EC products contain the same hormones as oral contraceptives, only in a higher dose. EC works primarily by preventing ovulation, but it can also prevent fertilization or implantation. However, timing is critical: EC is most effective when taken within 72 hours after unprotected intercourse. This is why OTC access is so important. There’s no need to wait for a doctors’ appointment to get a prescription, or to have the prescription filled.

While EC does not replace the consistent use of reliable birth control, making it available without a prescription to all provides an important safety net. For this reason, ACOG will continue to advocate for removing this unnecessary age restriction to OTC EC.