Oregon Health & Science University researchers have found that despite legislation in 19 states requiring insurers to cover a 12-month supply of contraception, patients aren't receiving a year's worth of their prescription; most receive just three months or less.
Their study recently published in the journal JAMA Health Forum shows that policies requiring coverage of a 12-month supply of short-acting hormonal contraception — most commonly the birth control pill — have not been fully implemented, resulting in no substantial increases nationally in year-long prescription orders. This leaves many patients at an increased risk for unintended pregnancy.
A common cause for decreased effectiveness with the pill is breaks in use, often due to running out of a prescription or a lapse in obtaining a refill. However, dispensing a longer-term supply of contraception — six or 12 months — is linked to improved continuous use, fewer breaks in coverage and health system savings.
"The decision of when or if to become pregnant is deeply personal," said Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity. "It shouldn't be impacted by a delay in getting to your pharmacy for a refill, or a pill package running out while on vacation."
To address this barrier, policymakers in 19 states have enacted 12-month contraceptive supply policies, which require insurers to cover the cost of dispensing a full year of coverage at once per prescription. However, OHSU researchers found that these policies have not been fully implemented and have failed to change current prescribing practices.
Using a difference-in-difference model, which compares changes in outcomes over time between populations, researchers looked at oral pill, patch and ring contraception prescriptions among nearly 4.8 million female Medicaid enrollees ages 18 to 44 in 36 states — 11 states with the 12-month supply policy, and 25 without. Researchers found that in 10 of the 11 states with the policy, an increase in the proportion of contraception dispensed was smaller than one percentage point — meaning just a nominal improvement in year-long prescription orders.
"Our findings suggest a significant gap in knowledge both for patients and prescribers, and we hope this serves as a call to action to make 12-month supplies the standard prescribing practice," Rodriguez said. "This is low-hanging fruit for improving birth control access, especially for people who live in states with more restrictions on reproductive health care."
For coverage policies to be effective, insurance companies must comply with and be held accountable for following the revised coverage guidelines, Rodriguez said. Similarly, clinicians would need to change their standard prescribing patterns to write for an extended supply of contraception, and pharmacists would need to dispense the full supply.
The research team says full implementation of these policies will require outreach to contraceptive users, prescribers, pharmacists and payers, as well as enforcement from state governments. A federal policy mandating coverage of a 12-month supply is another strategy to support access, as it would require all insurers, including private payers, to cover 12-month contraception supplies.
Rodriguez encourages patients to feel empowered to ask about their contraceptive options and advocate for choices that are the best fit their personal preferences, lifestyle and family planning goals.
"In our current health care landscape, where reproductive rights are constantly under attack, it's critical to remove barriers and ensure broad access to contraception," Rodriguez said. "We need providers to be following this prescribing practice as their default and patients to know that it's their right to ask for it."
This work was conducted with the support of Arnold Ventures. The sponsor had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and, decision to submit the manuscript for publication.
