OTC birth control pill covered by NM insurance

New Mexico’s insurance superintendent confirmed in a press release Friday (April 19) that insurance carriers in the state will cover Opill, the first overthe-counter birth control pill approved by the Food and Drug Administration.

The announcement follows the New Mexico Human Services Department’s decision on March 27 to cover Opill on Medicaid.

Opill was approved by the FDA in July 2023 and, when it was available in-store on March 4, became the first daily over-thecounter contraceptive pill available in the U.S. It allows consumers to access birth control pills over-the-counter at pharmacies rather than require a prescription.

New Mexicans insured through Medicaid and privately insured New Mexicans under OSI-regulated plans can now obtain Opill on the same basis as other over-the-counter contraceptive methods — such as condoms or emergency contraception — at no cost and without a prescription. New Mexicans covered by Medicaid additionally have access to no-cost pregnancy tests and emergency contraception.

The OSI said New Mexico health insurance carriers are required to cover the cost of the pill at in-network pharmacies and to have a reimbursement process for out-of-network pharmacies.

“OSI supports New Mexico’s commitment to expanding access to reproductive health and reproductive rights,” said Superintendent of Insurance Alice Kane.

“We are dedicated to ensuring access to health care for all Medicaid customers,” Alanna Dancis, chief medical officer for the New Mexico Medicaid program, said in the New Mexico Human Services Department’s press release. “The coverage of Opill is a step forward in empowering people with more choices in their reproductive health care — we encourage our customers and pharmacists to familiarize themselves with this new coverage option.”

The plans covering Opill are those regulated by OSI as well as Medicaid plans. The insurance superintendent’s office oversees and regulate most kinds of insurance in New Mexico but does not oversee self-funded employer plans, Medicare, or TRICARE.

New Mexicans covered under private health plans can file a complaint online at osi.state. nm.us/pages/misc/mhcb-complaint or by contacting Gurrattanpal “Mickey” Singh at gurrattanpal.singh@osi.nm.gov.