Tufts Health Plan Continues Contraceptive Coverage Under Massachusetts ACCESS Law
Provides members with coverage for FDA-approved contraceptive drugs, devices and other products
Tufts Health Plan continues its support and adherence to the Massachusetts ACCESS Law1 (Advancing Contraceptive Coverage and Economic Security in our State) that notably provides members with coverage for FDA-approved contraceptive drugs, devices and other products2 without cost sharing3 — including emergency contraceptives — and permits a member continuing on a prescription contraceptive to fill up to a 12-month supply of their prescription at one time. Since the ACCESS Law’s effective date in 2018, Tufts Health Plan has coordinated with pharmacists and providers to enable Massachusetts fully-insured commercial members4 and Medicaid members to have access to coverage for up to a 12-month supply of prescription birth control in a single dispensing to meet this legislative mandate.
Specifically, the ACCESS Law requires coverage of “prescription contraceptives intended to last for: (A) not more than a 3-month period for the first time the prescription contraceptive is dispensed to the covered person; and (B) for not more than a 12-month period for any subsequent dispensing of the same prescription, which may be dispensed all at once or over the course of the 12-month period,” regardless of whether the covered person was enrolled in the plan or policy at the time the prescription was first dispensed. In order to facilitate such access, providers must write the prescription for up to a 12-month supply. Members may not access more than one 12-month prescription in a single dispensing in a plan year.
Although self-insured, the Group Insurance Commission (GIC) is also subject to this law. Coverage for the GIC’s Tufts Health Plan members is administered by their pharmacy benefit manager. Other self-insured group health plans are not required to follow the coverage provisions of this Massachusetts law. If your plan is self-insured, your eligibility for this coverage will depend on your employer’s choice to add it.
If you have questions about your coverage, including whether your health plan is fully-insured or self-insured, contact Tufts Health Plan member services at the number on your member ID card.