Access to Contraception for Servicemembers and Dependents Act of 2023

II 118TH CONGRESS 1ST SESSION S. 1527 To amend title 10, United States Code, to ensure that members of the Armed Forces and their families have access to the contraception they need in order to promote the health and readiness of all members of the Armed Forces, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 10, 2023 Mrs. SHAHEEN (for herself, Ms. COLLINS, Ms. HIRONO, Ms. WARREN, Ms. STABENOW, Mr. MENENDEZ, Ms. HASSAN, Mrs. GILLIBRAND, Mr. BEN- NET, Mr. TESTER, Mr. BLUMENTHAL, Mr. KELLY, Ms. BALDWIN, Mr. KAINE, Mrs. MURRAY, Mr. DURBIN, Mr. BROWN, Mr. SANDERS, Ms. SMITH, and Mr. WYDEN) introduced the following bill; which was read twice and referred to the Committee on Armed Services A BILL To amend title 10, United States Code, to ensure that mem- bers of the Armed Forces and their families have access to the contraception they need in order to promote the health and readiness of all members of the Armed Forces, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Access to Contracep- 4 tion for Servicemembers and Dependents Act of 2023’’. 5 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1527 IS SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) Women are serving in the Armed Forces at 3 increasing rates, playing a critical role in the na- 4 tional security of the United States. Women com- 5 prise more than 18 percent of members of the 6 Armed Forces, and as of fiscal year 2019, more than 7 390,000 women serve on active duty in the Armed 8 Forces or in the reserve components. An estimated 9 several thousand transgender men also serve on ac- 10 tive duty in the Armed Forces and in the reserve 11 components, in addition to non-binary members and 12 those who identify with a different gender. 13 (2) Ninety-five percent of women serving in the 14 Armed Forces are of reproductive age and as of 15 2019, more than 700,000 female spouses and de- 16 pendents of members of the Armed Forces on active 17 duty are of reproductive age. 18 (3) The TRICARE program covered more than 19 1,570,000 women of reproductive age in 2019, in- 20 cluding spouses and dependents of members of the 21 Armed Forces on active duty. Additionally, thou- 22 sands of transgender dependents of members of the 23 Armed Forces are covered by the TRICARE pro- 24 gram. 25 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1527 IS (4) The right to access contraception is ground- 1 ed in the principle that contraception and the ability 2 to determine if and when to have children are inex- 3 tricably tied to one’s wellbeing, equality, dignity, and 4 ability to determine the course of one’s life. Those 5 protections have helped access to contraception be- 6 come a driving force in improving the health and fi- 7 nancial security of individuals and their families. 8 (5) Access to contraception is critical to the 9 health of every individual capable of becoming preg- 10 nant. This Act is intended to apply to all individuals 11 with the capacity for pregnancy, including cisgender 12 women, transgender men, non-binary individuals, 13 those who identify with a different gender, and oth- 14 ers. 15 (6) Studies have shown that when cost barriers 16 to the full range of methods of contraception are 17 eliminated, patients are more likely to use the con- 18 traceptive method that meets their needs, and there- 19 fore use contraception correctly and more consist- 20 ently, reducing the risk of unintended pregnancy. 21 (7) Under the TRICARE program, members of 22 the Armed Forces on active duty have full coverage 23 of all prescription drugs, including contraception, 24 without cost-sharing requirements, in line with the 25 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1527 IS Patient Protection and Affordable Care Act (Public 1 Law 111–148), which requires coverage of all con- 2 traceptive methods approved, cleared, or authorized 3 under section 505, 510(k), 513(f)(2), or 515 of the 4 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 5 355, 360(k), 360c(f)(2), 360e) and related services 6 and education and counseling. However, members 7 not on active duty and dependents of members do 8 not have similar coverage of all contraceptive meth- 9 ods approved, cleared, or authorized under section 10 505, 510(k), 513(f)(2), or 515 of the Federal Food, 11 Drug, and Cosmetic Act (21 U.S.C. 355, 360(k), 12 360c(f)(2), 360e) without cost-sharing when they ob- 13 tain the contraceptive outside of a military medical 14 treatment facility. 15 (8) In order to fill gaps in coverage and access 16 to preventive care critical for women’s health, the 17 Patient Protection and Affordable Care Act (Public 18 Law 111–148) requires all non-grandfathered indi- 19 vidual and group health plans to cover without cost- 20 sharing preventive services, including a set of evi- 21 dence-based preventive services for women supported 22 by the Health Resources and Services Administra- 23 tion of the Department of Health and Human Serv- 24 ices. Those women’s preventive services include the 25 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1527 IS full range of contraceptive methods approved, 1 cleared, or authorized under section 505, 510(k), 2 513(f)(2), or 515 of the Federal Food, Drug, and 3 Cosmetic Act (21 U.S.C. 355, 360(k), 360c(f)(2), 4 360e), education on effective family planning prac- 5 tices, and sterilization procedures. The Health Re- 6 sources and Services Administration has affirmed 7 that contraceptive care includes contraceptive coun- 8 seling, initiation of contraceptive use, and follow-up 9 care (such as management, evaluation, and changes 10 to and removal or discontinuation of the contracep- 11 tive). 12 (9) The Defense Advisory Committee on 13 Women in the Services has recommended that all 14 the Armed Forces, to the extent that they have not 15 already, implement initiatives that inform members 16 of the Armed Forces of the importance of family 17 planning, educate them on methods of contraception, 18 and make various methods of contraception avail- 19 able, based on the finding that family planning can 20 increase the overall readiness and quality of life of 21 all members of the Armed Forces. 22 (10) The military departments received more 23 than 8,866 reports of sexual assaults during fiscal 24 year 2021, an increase of more than 1,000 reports 25 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1527 IS compared to fiscal year 2019. Through regulations, 1 the Department of Defense already supports a policy 2 of ensuring that members of the Armed Forces who 3 are sexually assaulted have access to emergency con- 4 traception, and the initiation of contraception if de- 5 sired and medically appropriate. 6 SEC. 3. CONTRACEPTION COVERAGE PARITY UNDER THE 7 TRICARE PROGRAM. 8 (a) PHARMACY BENEFITS PROGRAM.—Section 9 1074g(a)(6) of title 10, United States Code, is amended 10 by adding at the end the following new subparagraph: 11 ‘‘(D) Notwithstanding subparagraphs (A), (B), and 12 (C), cost-sharing requirements may not be imposed and 13 cost-sharing amounts may not be collected with respect 14 to any eligible covered beneficiary for any prescription con- 15 traceptive on the uniform formulary provided through a 16 retail pharmacy described in paragraph (2)(E)(ii) or 17 through the national mail-order pharmacy program.’’. 18 (b) TRICARE SELECT.—Section 1075 of such title 19 is amended— 20 (1) in subsection (c), by adding at the end the 21 following new paragraph: 22 ‘‘(4)(A) Notwithstanding any other provision of 23 this section, cost-sharing requirements may not be 24 imposed and cost-sharing amounts may not be col- 25 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1527 IS lected with respect to any beneficiary under this sec- 1 tion for a service described in subparagraph (B) that 2 is provided by a network provider. 3 ‘‘(B) A service described in this subparagraph 4 is any contraceptive method approved, cleared, or 5 authorized under section 505, 510(k), 513(f)(2), or 6 515 of the Federal Food, Drug, and Cosmetic Act 7 (21 U.S.C. 355, 360(k), 360c(f)(2), 360e), any con- 8 traceptive care (including with respect to insertion, 9 removal, and follow up), any sterilization procedure, 10 or any patient education or counseling service pro- 11 vided in connection with any such contraceptive, 12 care, or procedure.’’; and 13 (2) in subsection (f), by striking ‘‘calculated as’’ 14 and inserting ‘‘calculated (except as provided in sub- 15 section (c)(4)) as’’. 16 (c) TRICARE PRIME.—Section 1075a of such title 17 is amended by adding at the end the following new sub- 18 section: 19 ‘‘(d) PROHIBITION ON COST-SHARING FOR CERTAIN 20 SERVICES.—(1) Notwithstanding subsections (a), (b), and 21 (c), cost-sharing requirements may not be imposed and 22 cost-sharing amounts may not be collected with respect 23 to any beneficiary enrolled in TRICARE Prime for a serv- 24 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1527 IS ice described in paragraph (2) that is provided under 1 TRICARE Prime. 2 ‘‘(2) A service described in this paragraph is any con- 3 traceptive method approved, cleared, or authorized under 4 section 505, 510(k), 513(f)(2), or 515 of the Federal 5 Food, Drug, and Cosmetic Act (21 U.S.C. 355, 360(k), 6 360c(f)(2), 360e), any contraceptive care (including with 7 respect to insertion, removal, and follow up), any steriliza- 8 tion procedure, or any patient education or counseling 9 service provided in connection with any such contraceptive, 10 care, or procedure.’’. 11 SEC. 4. PREGNANCY PREVENTION ASSISTANCE AT MILI- 12 TARY MEDICAL TREATMENT FACILITIES FOR 13 SEXUAL ASSAULT SURVIVORS. 14 (a) IN GENERAL.—Chapter 55 of title 10, United 15 States Code, is amended by inserting after section 1074o 16 the following new section: 17 ‘‘§ 1074p. Provision of pregnancy prevention assist- 18 ance at military medical treatment facili- 19 ties 20 ‘‘(a) INFORMATION AND ASSISTANCE.—The Sec- 21 retary of Defense shall promptly furnish to sexual assault 22 survivors at each military medical treatment facility the 23 following: 24 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1527 IS ‘‘(1) Comprehensive, medically and factually ac- 1 curate, and unbiased written and oral information 2 about all emergency contraceptives approved by the 3 Food and Drug Administration. 4 ‘‘(2) Upon request by the sexual assault sur- 5 vivor, emergency contraceptives or, if applicable, a 6 prescription for emergency contraceptives. 7 ‘‘(3) Notification of the right of the sexual as- 8 sault survivor to confidentiality with respect to the 9 information and care and services furnished under 10 this section. 11 ‘‘(b) INFORMATION.—The Secretary shall ensure that 12 information provided pursuant to subsection (a) is pro- 13 vided in language that— 14 ‘‘(1) is clear and concise; 15 ‘‘(2) is readily comprehensible; and 16 ‘‘(3) meets such conditions (including condi- 17 tions regarding the provision of information in lan- 18 guages other than English) as the Secretary may 19 prescribe in regulations to carry out this section. 20 ‘‘(c) DEFINITIONS.—In this section: 21 ‘‘(1) The term ‘sexual assault survivor’ means 22 any individual who presents at a military medical 23 treatment facility and— 24 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1527 IS ‘‘(A) states to personnel of the facility that 1 the individual experienced a sexual assault; 2 ‘‘(B) is accompanied by another person 3 who states that the individual experienced a 4 sexual assault; or 5 ‘‘(C) whom the personnel of the facility 6 reasonably believes to be a survivor of sexual 7 assault. 8 ‘‘(2) The term ‘sexual assault’ means the con- 9 duct described in section 1565b(c) of this title that 10 may result in pregnancy.’’. 11 (b) CLERICAL AMENDMENT.—The table of sections 12 at the beginning of such chapter is amended by inserting 13 after the item relating to section 1074o the following new 14 item: 15 ‘‘1074p. Provision of pregnancy prevention assistance at military medical treat- ment facilities.’’. SEC. 5. EDUCATION ON FAMILY PLANNING FOR MEMBERS 16 OF THE ARMED FORCES. 17 (a) EDUCATION PROGRAMS.— 18 (1) IN GENERAL.—Not later than one year 19 after the date of the enactment of this Act, the Sec- 20 retary of Defense shall establish a uniform standard 21 curriculum to be used in education programs on 22 family planning for all members of the Armed 23 Forces. 24 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1527.IS S1527 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1527 IS (2) TIMING.—Education programs under para- 1 graph (1) shall be provided to members of the 2 Armed Forces as follows: 3 (A) During the first year of service of the 4 member. 5 (B) At such other times as each Secretary 6 of a military department determines appro- 7 priate with respect to members of the Armed 8 Forces under the jurisdiction of such Secretary. 9 (3) SENSE OF CONGRESS.—It is the sense of 10 Congress that the education programs under para- 11 graph (1) should be evidence-informed and use the 12 latest technology available to efficiently and effec- 13 tively deliver information to members of the Armed 14 Forces. 15 (b) ELEMENTS.—The uniform standard curriculum 16 for education programs under subsection (a) shall include 17 the following: 18 (1) Information for members of the Armed 19 Forces on active duty to make informed decisions re- 20 garding family planning. 21 (2) Information about the prevention of unin- 22 tended pregnancy and sexually transmitted infec- 23 tions, including human immunodeficiency virus 24 (commonly known as ‘‘HIV’’). 25 VerDate Sep 11 2014 23:00 May 19, 2023 Jkt 039200 PO 00000 F [Text truncated for display. Full text available on Congress.gov.]