Contraceptives In Recommended Preventive Services

A new report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the services that health plans will cover at no cost to patients under a provision of the Patient Protection and Affordable Care Act of 2010. The recommendations include one for contraceptive services, which is likely to be the most controversial of the IOM’s proposals.

The ACA requires group health plans to cover, with no cost sharing, the following:
• certain evidence-based items (with A or B ratings) in the recommendations of the United States Preventive Services Task Force, a part of the Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality;
• immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
• evidence-based preventive care and screenings for infants, children, and adolescents provided for in the comprehensive guidelines supported by the HHS’s Health Resources and Services Administration (HRSA); and
• additional women’s preventive care and screenings “in comprehensive guidelines supported by the HRSA.”

At the HHS’s request, an IOM committee identified critical gaps in preventive services for women, as well as measures that will further ensure women’s health and well-being.

The IOM committee's eight recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The committee identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions. The report suggests the following additional services:

• screening for gestational diabetes;
• human papillomavirus (HPV) testing as part of cervical cancer screening for women who are older than age 30;
• counseling on sexually transmitted infections;
• counseling and screening for HIV;
• contraceptive methods and counseling to prevent unintended pregnancies;
• lactation counseling and equipment to promote breastfeeding;
• screening and counseling to detect and prevent interpersonal and domestic violence; and
• yearly well-woman preventive care visits to obtain recommended preventive services.

The report also recommends that HHS’s guidelines on preventive health services for women be updated routinely in light of new science. As part of this process, HHS should establish a commission to recommend which services health plans should cover, noted the IOM. The commission should be separate from the groups that assess evidence of health services’ effectiveness, and it should consider cost-effectiveness analyses, evidence reviews, and other information to make coverage recommendations.