I want to take note of something within this that Ms Fluke and Ms Pelosi might find interesting.
Earlier I documented some prices of birth control and wondered which version was to be covered without “cost sharing” and without raising premiums.
In the dump we get the answer [bold is mine]:
The Departments’ interim final regulations implementing section 2713 of the PHS Act provide that “[n]othing prevents a plan or issuer from using reasonable medical management techniques to determine the frequency, method, treatment, or setting for an item or service … to the extent not specified in the recommendation or guideline.”7 The preamble to the interim final regulations further provides:
“The use of reasonable medical management techniques allows plans and issuers to adapt these recommendations and guidelines to coverage of specific items and services where cost sharing must be waived. Thus, under these interim final regulations, a plan or issuer may rely on established techniques and the relevant evidence base to determine the frequency, method, treatment, or setting for which a recommended preventive service will be available without cost sharing requirements to the extent not specified in a recommendation or guideline.” (75 FR 41728-29).8
This policy applies to contraceptive coverage. The Departments plan to issue further guidance on section 2713 of the PHS Act more generally.
I have my doubts that $1000/year is “reasonable” as a “medical management technique” for contraceptive coverage when there are so many different and cheaper alternatives.
UPDATE: I am pretty certain this doesn’t need to be spelled out to my readers (thank you readers!) but in case there is a passer by who might need the analysis, what this also does besides upsetting the Flukes of this world is reduce innovation.
a) birth control is to be provided by your mandatory insurance for free
b) the insurance company can determine the most cost effective form of birth control that it is willing to provide for free
c) 99% of women using birth control choose free over a copay version
d) R&D quits bothering coming out with newer and improved and safer methods of birth control because they are going to be more expensive on first pass and hence will not be used.
Research and Development is already a big gamble. Many companies find it easier to just ‘improve what’s out there (me too drugs)’ (link is to a NYbooks article I didn’t read all the way through concerning the “costs” of R&D and what big Pharma says vs does) and most people believe we’re losing our edge as is. This new law will definitely help us continue on that path to lesser innovation.