UnitedHealthcare must pay New York $1 million penalty for failing to provide mandated coverage of birth control

UnitedHealthcare of New York, Inc., the nation's largest health insurer, must pay a $1 million penalty to the state after it failed to provide required coverage of birth control, Attorney General Letitia James announced Thursday.

This action follows a complaint the attorney general’s office received from a Brooklyn patient whose oral contraceptive prescription was denied by UnitedHealthcare’s Oxford health plan, contravening New York’s Comprehensive Contraceptive Coverage Act (CCCA), according to James' office.

The CCCA mandates that health insurance must cover FDA-approved contraceptives without copays, restrictions or delays.

In a statement, James said, “Denying health insurance coverage of birth control can cause serious health concerns for anyone who takes the medication,” encouraging patients who have been denied proper birth control coverage to file a complaint with her office.

The office of the attorney general initiated an investigation following the Brooklyn patient's complaint, discovering that UnitedHealthcare had not only denied coverage, but also required the patient to obtain prior authorization or go through step therapy. That process requires patients to try alternative treatments and delays a patient's access to necessary contraceptives, further violating the CCCA, the office said.

In addition to the $1 million penalty, UnitedHealthcare must refund consumers who paid out-of-pocket for their birth control after being denied coverage, plus 12% interest. Eligible individuals will receive reimbursement via mail, while those with potential claims will be notified to submit them.

UnitedHealthcare released a statement saying: “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.”

UnitedHealthcare said the oral contraceptive in the settlement, Slynd, does not contain estrogen and is an option for people who cannot take estrogen due to certain medical conditions.

The company said it is “committed to women’s health, including ensuring the people we serve have timely access to a variety of high-value and affordable FDA-approved contraceptives when they need them. In fact, UnitedHealthcare provides access to more than 150 FDA-approved contraceptive options with $0 cost-share.”

“It is encouraging that Attorney General James is using the CCCA to ensure that people can get the contraception that they need,” Allie Bohm, senior policy counsel at the New York Civil Liberties Union, said in an interview.

In addition to preventing pregnancy, birth control pills provide many health benefits for patients, including treatment of menstrual disorders such as endometriosis and dysmenorrhea, Bohm said.

“Unfortunately, I think we do see some of the same implementation problems with insurers when it comes to responsibility … we still need our insurers to check the law and catch up to what really is serving their customers,” Bohm said.