WASHINGTON – December 4, 2023 – The ERISA Industry Committee (ERIC) today said it supports coverage of over-the-counter (OTC) preventive items and services – including contraceptive items and services – provided they are of high-quality and are clinically proven to improve health outcomes. However, ERIC voiced concerns with requiring self-insured plans to provide coverage without cost-sharing and without a prescription, and offered solutions to address operational challenges and barriers to access.
ERIC’s position was outlined in its response to a Request for Information (“RFI”) from the U.S. Departments of Labor, Health and Human Services, and the Treasury (“the Departments”) regarding the application of the preventive services requirements under section 2713 of the Public Health Services Act (“PHSA”) to over-the-counter (“OTC”) preventive items and services available without a prescription by a health care provider.
“ERIC members invest heavily in preventive care items and services for their employees. We share the policy goal with the Departments of increasing access for patients,” said James Gelfand, ERIC President and CEO. “But expanding coverage needs to be done in a way that protects health, drives value for patients, and controls costs for employer-sponsored health plans. Our comment letter offers solutions to the Departments on how to increase access to OTC items and services without a prescription and cost-sharing, and without breaking the bank or jeopardizing patient health. ERIC also highlights operational challenges and barriers that will need to be addressed so that plan sponsors and participants, pharmacies, retailers, and the existing health care delivery system will not be negatively impacted.”
In its comments, ERIC urges the Departments to recognize the overarching need for the adoption of proper substantiation and payment processes, strict adherence to the existing rules and requirements, and application of appropriate guardrails to ensure appropriate access to OTC preventive items and services.
To review ERIC’s full response to the Departments’ RFI, click here.
