UnitedHealth unit to pay New York $1M over birth control step therapy move

New York state officials gave health insurers a lesson Thursday on the breadth of the state’s Comprehensive Contraceptive Coverage Act.

The state negotiated a $1 million settlement with UnitedHealth’s UnitedHealthcare of New York unit over allegations that it required a plan participant to try an alternative to a progestin-only oral contraceptive, Slynd, before it would let her use Slynd.

Slynd costs about $200 per month, and there are no generic alternatives, according to GoodRx.

UnitedHealth told the patient it had safety concerns about a progestin-only contraceptive. New York officials believe that a progestin-only contraceptive may be a good option for patients with certain health conditions, such as high blood pressure or migraines, according to the settlement document.

The case started with a complaint from the patient, officials said.

UnitedHealthcare of New York imposed a prior authorization requirement on use of Slynd and a “step therapy” process, or a requirement that the plan participant try one drug before getting the requested drug, and that violated the state’s contraceptive coverage act, officials found.

The Affordable Care Act requires individual major medical insurance and small-group health insurance plans throughout the country to cover birth control without cost-sharing.

The New York contraceptive coverage act requires health insurers to cover at least one version of each type of contraceptive approved by the  U.S. Food and Drug Administration without co-payments or coverage access restrictions, officials said.

Related: FDA panel backs approval of first over-the-counter birth control pill

In addition to paying the $1 million penalty, UnitedHealthcare must update its contraceptive coverage rules and mail refunds to consumers who faced out-of-pocket costs for contraceptives from June 1, 2020, to the present.

UnitedHealthcare will send refunds, plus 12%, to many consumers with clear-cut cases automatically. Others with less clear situations may need to submit claims to UHC_NYContraceptives_support@uhc.com.

UnitedHealthcare neither admitted nor denied state investigators’ findings.

New York Attorney General Letitia James indicated that she would be happy to start similar actions against other insurers.

“I encourage anyone who may have had their birth control coverage denied by their health insurance company to contact my office and file a complaint,” she said.

UnitedHealthcare said in a statement that it’s committed to women’s health, including ensuring that the people we serve have timely access to a variety of high-value and affordable FDA-approved contraceptives.

“UnitedHealthcare provides access to more than 150 FDA-approved contraceptive options with $0 cost-share,” the company said. “We apologize for the delay in access to one brand of progestin-only oral contraceptive in New York. We are in the process of resolving these claims with our members.”

New York state’s Hudson Valley. Elisa/Adobe Stock