Affordability is Access Act of 2026
- Sponsor
- Rep. Pressley, Ayanna [D-MA-7]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Sep 24, 2026
Bottom line
This bill aims to expand access to affordable birth control by mandating insurance coverage for over-the-counter options without a prescription or cost-sharing, while also ensuring coverage for prescription options.
What it actually does
This bill, the "Affordability is Access Act of 2026," mandates that group health plans and health insurance coverage provide full coverage for all FDA-approved over-the-counter (OTC) contraceptives without requiring a prescription or cost-sharing. It also clarifies that prescription contraceptives must be covered, allowing plans to cover at least one therapeutically equivalent option without cost-sharing. Additionally, it prohibits retailers from interfering with an individual's access to or purchase of OTC contraceptives.
Proponents argue
Proponents argue the bill is crucial for ensuring timely and affordable access to birth control, which is essential healthcare with significant health and economic benefits for individuals, families, and communities, especially for marginalized groups who face greater barriers. They emphasize that making OTC birth control affordable is as important as making it accessible, and that current gaps in coverage hinder consistent use.
Opponents contend
Potential opponents might argue that mandating coverage for OTC products could increase insurance premiums, imposing undue burdens on health plans and employers. Some may also contend that existing coverage requirements for prescription contraceptives are sufficient, or raise concerns about the role of a prescription in ensuring appropriate medical guidance for contraceptive use.
The bill is concise and straightforward, allowing a reader to quickly grasp its core provisions and implications.
Section 5(1)
Mandated Coverage for Over-the-Counter Contraceptives
This provision clarifies that health plans must cover all FDA-approved, granted, or cleared over-the-counter (OTC) contraceptives without requiring a prescription and without cost-sharing. This means individuals can purchase these contraceptives directly from a retailer and have their insurance cover the full cost, even if they haven't seen a doctor for a prescription.
Supporters argue
Supporters argue this provision directly addresses barriers to access by removing the need for a doctor's visit and associated costs (time off work, co-pays) for OTC birth control, making it truly accessible and affordable as intended by the ACA's birth control benefit.
Critics contend
Critics might argue that this mandate could lead to increased premiums for all insured individuals, as health plans pass on the additional costs of covering OTC products without a prescription. Some may also argue that a medical consultation is important for safe and effective contraceptive use, even for OTC options.
Tradeoffs
This provision balances the goal of maximizing access and affordability for contraception against potential increases in insurance premiums and the traditional role of medical oversight in healthcare.
Section 5(2)
Coverage for Therapeutically Equivalent Prescription Contraceptives
This provision clarifies that health plans must cover all FDA-approved prescription contraceptives. However, if there are multiple therapeutically equivalent prescription drugs (meaning they have the same active ingredients, dosage form, strength, and route of administration), the plan is only required to cover one of these without cost-sharing. This allows plans to manage costs by covering a generic or preferred brand.
Section 7
Non-Interference with OTC Contraceptive Access by Retailers
This section mandates that any retailer stocking FDA-approved over-the-counter contraception cannot interfere with an individual's access to or purchase of such contraception, nor with their access to medically accurate information about it. It clarifies that retailers are not required to provide contraception if the individual cannot pay for it (directly, via insurance, or other means).
States that nothing in the Act modifies or interferes with Food and Drug Administration (FDA) processes for review, approval, safety, efficacy determinations, or other FDA authority regarding non-prescription drugs or devices.
Section 6(a)
Why it matters:It is standard legislative practice to clarify jurisdictional boundaries and prevent unintended interpretations that might challenge existing regulatory frameworks, ensuring the bill focuses solely on insurance coverage and access.
Case for: Ensures the bill focuses solely on insurance coverage and access, without attempting to legislate scientific or medical standards, thereby respecting the FDA's expertise and authority and preventing legal challenges based on claims of legislative overreach.
Case against: No direct case against, as it is a clarifying provision. Some might argue it highlights the bill's limited scope in addressing broader issues of drug approval, but this is not an argument against the provision itself.
Estimated impact: Prevents legal challenges based on claims of legislative overreach into FDA's domain, maintaining regulatory clarity and stability for pharmaceutical companies.
Clarifies that the Act does not preempt any provision of Federal or State law to the extent that such Federal or State law provides protections for consumers that are greater than the protections provided for in this Act.
Section 6(b)
Why it matters:It is standard legislative practice to ensure that the federal law sets a floor, not a ceiling, for consumer protections, allowing states to enact more protective measures without being superseded.
Case for: Ensures that states or other federal laws can continue to offer or enact stronger consumer protections related to contraceptive access and coverage, promoting a race to the top for consumer benefits and allowing for local innovation in policy.
Case against: No direct case against. While some might argue it could lead to a patchwork of regulations, this is generally accepted for consumer protection laws where federal law establishes a minimum standard.
Estimated impact: Preserves the ability of states to innovate and provide enhanced protections, potentially leading to varied levels of access and coverage across jurisdictions, but always at or above the federal minimum.