Connecticut Medicaid No Longer Covering Essure Birth Control

Over the past few years, Bayer has been pulling their Essure permanent birth control devices off the market in countries around the world, citing changes in patient demand. But despite thousands of patient complaints, innumerable lawsuits, and increased federal restrictions on the device, U.S. Essure sales have continued unabated until now. The global revolt against Essure permanent birth control will reach U.S. shores this July, at least in Connecticut, as the state’s Department of Social Services has announced that Medicaid will no longer cover the cost of implanting Essure.

Connecticut’s decision to suspend coverage of the sterilization device follows closely on the heels of the FDA’s added restrictions on Essure. Citing the recently imposed action as a direct result of the policy change, Connecticut’s DSS will suspend Medicaid coverage of Essure implantation effective July 1, 2018.

“Effective for dates of service July 1, 2018 and forward, the permanent implantable contraceptive intratubal occlusion device and delivery system that is used as part of bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants procedure will no longer be covered under the Healthcare Common Procedure Coding System (HCPCS) code A4264-Intratubal occlusion device. Other birth control devices such as the Falope ring and filshie clips remain covered and should continue to be billed under HCPCS code A4264.

Additionally, Current Procedure Terminology (CPT) code 58565-Hysteroscopy sterilization will be enddated for dates of service, July 1, 2018 and forward on the following fee schedules: physician-surgical, ambulatory surgical centers, and family planning clinics. The CPT code will be changed to a “no” under the payment type column on the Connecticut Medical Assistance Program Addendum B for outpatient hospitals.”

Though not directly named in the policy update, Essure is currently the only permanent tubal occlusion device on the market.

This change in policy is being seen by many anti-Essure advocates as a major step in eliminating the device in the U.S. When the Essure was first banned in Brazil in the spring of 2017, many countries began to follow suit. Currently, Bayer has ceased all sales of Essure outside of the United States.