The Convenient Contraception Act amends the Public Health Service Act to require group health plans and health insurance issuers offering group or individual coverage to permit an enrollee to obtain, at the enrollee’s option, up to a 365‑day supply of contraceptives (including in a single fill or refill) for contraceptives that are already required to be covered—without imposing cost‑sharing tied to the preventive‑services requirement. The change is written as an addition to section 2713(a) and takes effect for plan years beginning on or after January 1, 2026.
The bill also directs HHS, Labor, and the Treasury to begin outreach within 90 days of enactment to inform providers and enrollees about the new benefit. For compliance officers, benefits managers, and pharmacy operations, the bill moves a regulatory obstacle—short dispenses and repeated fills—out of routine practice and places several operational decisions around dispensing, reimbursement, and inventory squarely on plans, issuers, PBMs, and pharmacies.
At a Glance
What It Does
The bill amends section 2713(a) of the Public Health Service Act to require plans and issuers to permit enrollees to obtain up to a 365‑day supply of contraceptives that are otherwise required to be covered, allowing that supply to be filled in one transaction and prohibiting cost‑sharing tied to that preventive‑services requirement.
Who It Affects
Group health plans, health insurance issuers offering group or individual coverage, self‑insured employers that are subject to the PHSA amendment, PBMs, pharmacies, clinicians who prescribe contraceptives, and enrolled individuals seeking longer supplies.
Why It Matters
This changes a common plan design constraint—short dispensing intervals—into a mandatory enrollee option, likely reducing pharmacy visits and adherence barriers while prompting operational and reimbursement changes for payers and pharmacies.
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What This Bill Actually Does
The bill inserts a single, focused requirement into the preventive‑services section of the Public Health Service Act: when a contraceptive is already a covered preventive service under that section, plans and issuers must allow an enrollee to get the total day supply of that contraceptive up to 365 days without cost‑sharing tied to the preventive‑services rule. The requirement explicitly covers both group plans and health insurance issuers offering group or individual coverage and permits the enrollee to choose a single fill or refill to receive the full supply.
The text does not expand which contraceptives are covered; it applies only to contraceptives “for which coverage is otherwise required.” It is therefore a packaging-and‑dispensing rule layered on top of whatever contraceptive coverage obligations already exist under federal law. The amendment becomes operative for plan years beginning on or after January 1, 2026, giving plans and issuers a lead time to adjust formularies, claims systems, and pharmacy contracts.Separately, the bill requires HHS, the Labor Department, and Treasury to start outreach within 90 days of enactment to notify providers and enrolled (or eligible) individuals about the new benefit.
The outreach obligation does not create an enforcement mechanism or a private right of action in the statutory text; it is an administrative step intended to promote awareness among clinicians, pharmacies, and patients. The bill is silent about permitting or restricting utilization management tools such as prior authorization, quantity limits beyond the 365‑day cap, or how plans should handle inventory and reimbursement logistics when pharmacies dispense a year’s supply in one transaction.
The Five Things You Need to Know
The bill amends 42 U.S.C. 300gg–13(a) to require plans and issuers to permit enrollees to obtain up to a 365‑day supply of contraceptives that are already required to be covered.
An enrollee may choose a single fill or single refill to receive the total day supply (subject to the 365‑day cap) at their option.
Insurers and plans may not impose cost‑sharing under the preventive‑services paragraph for the 365‑day supply; the statutory language prohibits cost‑sharing tied to that paragraph.
The requirement applies to plan years beginning on or after January 1, 2026, giving plans and issuers lead time to operationalize changes.
HHS, the Department of Labor, and the Treasury must begin outreach within 90 days of enactment to inform providers and eligible enrollees about the new benefit.
Section-by-Section Breakdown
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Short title — 'Convenient Contraception Act'
This short title provision identifies the bill and is procedural. Practically, it matters only for reference and statutory citation; it does not change obligations or create substantive compliance duties.
Amendment to PHSA §2713(a) — 365‑day supply requirement
This is the operative change. The bill directs the Secretary to require group health plans and health insurance issuers offering group or individual coverage to permit enrollees to obtain the total day supply of a contraceptive—up to 365 days—without cost‑sharing under the preventive‑services paragraph. The text allows the enrollee to choose a single fill or refill, which removes the plan design lever that forces repeated monthly or quarterly dispensing. For compliance teams, the immediate implications are claims‑processing changes, updates to pharmacy benefit rules, and coordination with PBMs to accept claims for 365‑day quantities.
Effective date — plan years beginning January 1, 2026
The amendment applies to plan years that begin on or after January 1, 2026. That creates a clear temporal trigger but leaves room for non‑calendar year plans to interpret applicability based on their plan year start date. Benefits administrators must map plan year definitions and update plan documents, SBCs, and participant notices accordingly.
Interagency outreach obligation
HHS, the Department of Labor, and the Treasury must jointly conduct outreach within 90 days of enactment to inform health care providers and eligible enrollees about the new benefit. The provision allocates responsibility for education and communication but does not specify the content, channels, or enforcement of that outreach. Agencies will need to determine whether guidance, FAQs, model notices, or technical assistance will best reduce confusion among plans, pharmacies, and clinicians.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Individuals who use contraceptives — Reduced logistical barriers and fewer pharmacy visits for people who prefer or need a longer supply (for example, rural patients, those with transportation or childcare constraints, and people with unstable work schedules).
- Clinicians and family‑planning providers — Fewer appointment‑driven refill needs and improved adherence prospects, making long‑term contraceptive counseling more actionable.
- Public health programs and payers focused on prevention — Potential for improved contraceptive continuity and fewer unintended pregnancies, which can lower downstream clinical and social costs.
Who Bears the Cost
- Health insurance issuers and group health plans (including self‑insured employers) — Must alter benefit administration, accept claims for 365‑day quantities, and absorb inventory‑timing and reimbursement impacts even though the statute bars cost‑sharing tied to the preventive‑services paragraph.
- Pharmacies and PBMs — Operational and cash‑flow effects from dispensing larger quantities in a single transaction, changes to stocking and billing procedures, and renegotiation of reimbursement terms with payers.
- Federal agencies (HHS, DOL, Treasury) — Administrative burden to produce outreach materials and technical guidance within 90 days, and potential ongoing resource needs to respond to implementation questions from plans and providers.
Key Issues
The Core Tension
The central tension is between improving individual access and adherence by enabling up‑front, year‑long dispensing and the financial and logistical burdens this shifts to payers and pharmacies; increasing convenience may reduce barriers for end users but creates distributional and operational costs that plans, PBMs, and pharmacies must absorb or negotiate around.
Key implementation ambiguities will drive disputes and administrative burden. First, the bill applies only to contraceptives “for which coverage is otherwise required,” so parties must determine the set of products that qualify under existing preventive‑services coverage rules; that linkage creates dependency on other statutory and regulatory definitions.
Second, the statute prohibits cost‑sharing under the preventive‑services paragraph but is silent about other utilization controls: it does not explicitly forbid prior authorization, step therapy, or clinically based quantity limits outside the cost‑sharing context. Plans and issuers could seek to retain non‑cost barriers, producing litigation or regulatory friction over the scope of permissible management.
Operationally, dispensing a year’s supply in one transaction raises practical questions about pharmacy reimbursement timing, manufacturer rebates, inventory shrinkage, and whether state pharmacy laws on dispensing limits or controlled quantity rules intersect with the federal mandate. The bill also lacks explicit enforcement provisions: it orders the Secretary to require the coverage but does not articulate penalties, civil remedies, or a private right of action, leaving enforcement to the agencies’ existing authorities and administrative processes.
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