Commissioner Lara addresses insurance coverage for medication abortion following Texas court ruling
News: 2023 Press Release
LOS ANGELES – With a Texas judge attempting to revoke approval of a medication commonly used in abortion care, the Department of Insurance has shared information about how California law protects insurance coverage. The preliminary injunction published today in the Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration does not make immediate changes with regard to medication abortion in California because the decision is stayed for seven days pending appeal by the Food and Drug Administration. The ruling addresses FDA approval of mifepristone, one of two pills commonly used in medication abortion care.
“All Californians have the right to safe, legal abortion care,” said Insurance Commissioner Ricardo Lara. “We must continue to defend the right to reproductive freedom in the face of continued attacks. California law is clear in protecting insurance coverage for medication prescribed in abortion. A judge in Texas cannot take away Californians’ basic rights.”
Under California law, abortion care is basic health care covered by most insurance. The Department FAQ about insurance coverage for abortion is available on our website: https://www.insurance.ca.gov/01-consumers/110-health/30-have/Coverage-for-Abortion.cfm
FAQ: How medication abortion is covered by insurance
Does the Texas ruling affect California?
It could if the FDA is eventually forced to withdraw its approval of mifepristone. Until then the California Department of Insurance will continue to require insurance coverage for this safe and tested medication.
Will I still be able to access medication abortion?
Yes. Even if mifepristone becomes unavailable to California patients, abortion providers can use an alternative medication which has been found to be safe and effective. Physicians could prescribe a misoprostol-only medication abortion regimen to ensure that patients seeking abortion in the state are able to access this care without interruption.
Is my private insurer required to cover my medication abortion?
Yes. If an insurance policy covers prescription drugs, it must cover all medically necessary medications prescribed by a physician. Insurance companies must cover outpatient abortion services without utilization management or prior authorization.
Policyholders who need help understanding their coverage should contact the Department of Insurance at
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Led by Insurance Commissioner Ricardo Lara, the California Department of Insurance is the consumer protection agency for the nation's largest insurance marketplace and safeguards all of the state’s consumers by fairly regulating the insurance industry. Under the Commissioner’s direction, the Department uses its authority to protect Californians from insurance rates that are excessive, inadequate, or unfairly discriminatory, oversee insurer solvency to pay claims, set standards for agents and broker licensing, perform market conduct reviews of insurance companies, resolve consumer complaints, and investigate and prosecute insurance fraud. Consumers are urged to call 1-800-927-4357 with any questions or contact us at www.insurance.ca.gov via webform or online chat. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.