Research shows that gaps exist in access to long-term contraceptives

Researchers at Oregon Health & Science University found that despite legislation in 19 states requiring insurers to cover a 12-month supply of contraception, patients are not receiving a year’s worth of prescriptions; most receive only three months or less.

Their study, recently published in the news JAMA Health Forumshows that policies requiring coverage of a 12-month supply of short-acting hormonal contraception – usually the contraceptive pill – have not been fully implemented, resulting in no substantial national-level increases in year-long prescriptions. This puts many patients at increased risk of an unintended pregnancy.

A common cause of decreased effectiveness of the pill is interruptions in use, often due to running out of a prescription or being unable to obtain a refill. However, providing a longer-term supply of contraceptives—six or 12 months—is associated with better continued use, fewer interruptions in coverage, and savings in the health care system.

“The decision of whether and when to get pregnant is deeply personal,” says Maria Rodriguez, MD, MPH, professor of obstetrics and gynecology at the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity. “This should not be affected by a delay in reaching your pharmacy for a refill, or a pill pack running out while you are on holiday.”

To address this barrier, policymakers in 19 states have adopted 12-month contraceptive policies that require insurers to cover the cost of providing a full year of coverage at once per prescription. However, the OHSU researchers found that these policies have not been fully implemented and have failed to change current prescribing practices.

Using a differentiation-in-difference model, which compares changes in outcomes over time across populations, researchers looked at contraceptive prescriptions for oral pills, patches and rings 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 where this policy is in place, the increase in the number of contraceptives dispensed was less than one percentage point – representing only a nominal improvement in the number of prescriptions filled for a year.

“Our findings indicate a significant knowledge gap among both patients and prescribers, and we hope this serves as a call to action to make 12-month supplies standard prescribing practice,” said Rodriguez. “This is low-hanging fruit for improving access to contraception, especially for people living 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, physicians would need to change their standard prescribing patterns to prescribe a comprehensive supply of contraceptives, and pharmacists would need to dispense the full range.

The research team says full implementation of these policies will require outreach to contraceptive users, prescribers, pharmacists and payers, as well as enforcement by 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 contraceptives for a 12-month period.

Rodriguez encourages patients to feel empowered to ask about their contraceptive options and advocate for choices that best fit their personal preferences, lifestyle and family planning goals.

“In our current healthcare landscape, where reproductive rights are under constant attack, it is critical to remove barriers and ensure broad access to contraception,” said Rodriguez. “We need healthcare providers to follow this prescribing practice as standard and patients need to know it is their right to request it.”