2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 38B - Women’s Rights Regarding Certain Health Insurance › § 31–3834.03. Coverage of additional preventive health services

§ 31–3834.03. Coverage of additional preventive health services.
(a) Health insurance coverage through Medicaid or the D.C. Healthcare Alliance program shall also provide coverage for and shall not impose any cost-sharing requirements for the following:
(1) Voluntary sterilization procedures for women;
(2)(A) All contraceptive drugs, devices, products and services approved by the U.S. Food and Drug Administration ("FDA"), including emergency contraception; provided, that:
(B) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, product, or service, coverage shall also include either the original FDA-approved contraceptive drug, device, product, or service or at least one of its therapeutic equivalents, without imposing any cost-sharing requirements;
(C) If the covered contraceptive drug, device, product, or service is deemed medically inadvisable by a provider, the health insurer shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements; and
(D) Nothing in this section shall prohibit a health insurer from requiring the use of a generic prescription drug when providing coverage for preventive contraceptive drugs, devices, products, or services, so long as such health insurer:
(i) Has a process for a member to seek medically necessary coverage of a covered brand name contraceptive drug, device, product, or service as determined by the member's prescribing provider; and
(ii) Provides coverage for a brand name contraceptive drug, device, product, or service when there is no generic substitute available in the market;
(3) Contraceptive services including consultation with a pharmacist, patient education, and counseling on contraceptive drugs, devices, products, or services; and
(4) Follow-up services related to the drugs, devices, products, and services covered under this section, including management of side effects, counseling for continued adherence, and device insertion and removal.
(b) Beginning on January 1, 2019, or the next date when carrier forms are approved, whichever is earlier, an individual health plan or group health plan shall also provide coverage for and shall not impose any cost-sharing requirements for all drugs, devices, products, and services listed in subsection (a) of this section; provided, that an individual health plan or group health plan subject to this subsection may require a co-payment or cost sharing for coverage of male contraceptive products for an enrollee covered by a high deductible health plan, as defined in section 1201(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, approved December 8, 2003 (117 Stat. 2066; 26 U.S.C. § 223(c)(2)).
(Apr. 3, 2001, D.C. Law 13-254, § 5c ; as added Mar. 28, 2018, D.C. Law 22-75, § 3(b), 65 DCR 1374; Oct. 30, 2018, D.C. Law 22-164, § 303(b), 65 DCR 9324.)
Emergency Legislation
For temporary (90 days) creation of this section, see § 3(b) of Defending Access to Women's Health Care Services Congressional Review Emergency Amendment Act of 2018 (D.C. Act 22-266, Feb. 21, 2018, 65 DCR 2119).