Under The Affordable Care Act, coverage of certain preventive services, including contraceptives, must be provided at no cost. For a list of no cost contraceptives, click here or go to Section 5(f) of your official plan brochure for additional details. If you or your prescriber believes that a non-formulary contraceptive is medically necessary, please follow the below process.
Contraceptive process:
- Reviews can be initiated by the member, pharmacist or provider
- Members should call Express Scripts at 1-800-841-2734
- Providers can also initiate through an electronic prior authorization
Processing Time for Contraceptive Exception Requests – Exception requests for contraceptive coverage will be processed within 24 hours of receiving complete information.
If the contraceptive is over-the-counter (OTC) and has a National Drug Code (NDC), present your Foreign Service Benefit Plan (FSBP) ID card and the prescription from your provider at the pharmacy.
If you purchase an OTC contraceptive that does not have an NDC, you must file a claim for reimbursement. For additional detail on how to file your claim, see Section 7. Filing a Claim for Covered Services in the FSBP Plan Brochure.
You can learn more about contraception resources and reproductive rights at these websites:
Please contact OPM if you have difficulty accessing contraceptive coverage or other reproductive health by contacting contraception@opm.gov.