Researchers at Oregon Health & Science University have found that despite legislation in 19 states requiring insurers to cover a 12-month supply of contraceptives, patients are not receiving a full year’s supply of their prescriptions; most receive only three months or less.
Their study was recently published in the journal JAMA Health Forum The study shows that policies requiring coverage of a 12-month supply of short-acting hormonal contraceptives (most commonly the birth control pill) have not been fully implemented, resulting in no substantial nationwide increase in orders for a year’s supply of the medication. This leaves many patients at increased risk for unintended pregnancies.
A common cause of decreased effectiveness of the pill is discontinuation of use, often due to running out of prescriptions or failure to obtain a refill. However, providing a longer-term supply of contraceptives (six or twelve months) is linked to improved continued use, fewer gaps in coverage, and savings to the health system.
“The decision of whether or not to get pregnant, or when to do so, is a deeply personal one,” said Maria Rodriguez, M.D., professor of obstetrics and gynecology at the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity. “It shouldn’t be affected by a delay in getting to the pharmacy to refill your prescription or running out of a pack of pills during the holidays.”
To address this barrier, policymakers in 19 states have enacted 12-month contraceptive dispensing policies, which require insurers to cover the cost of dispensing a full year of coverage at one time 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-differences model, which compares changes in outcomes over time across populations, the researchers looked at prescriptions for oral contraceptives in the form of the pill, patch, and ring among nearly 4.8 million Medicaid-enrolled women ages 18 to 44 in 36 states (11 states with the 12-month supply policy and 25 without). The researchers found that in 10 of the 11 states with the policy, the increase in the share of contraceptives dispensed was less than one percentage point, meaning there was only a nominal improvement in one-year prescription orders.
“Our findings indicate that there is a significant gap in knowledge among both patients and prescribing physicians, and we hope it will serve as a call to action to make 12-month supplies standard prescribing practice,” Rodriguez said. “This is an easy opportunity to improve 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 the revised coverage guidelines and be held accountable for their compliance, Rodriguez said. Similarly, physicians would have to change their standard prescribing patterns to prescribe an extended supply of contraceptives, and pharmacists would have to dispense the full supply.
The research team says that 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 requiring coverage of a 12-month supply is another strategy to support access, as it would require all insurers, including private insurers, to cover a 12-month supply of contraceptives.
Rodriguez encourages patients to feel empowered to ask about their contraceptive options and advocate for the options that best fit their personal preferences, lifestyle and family planning goals.
“In today’s healthcare landscape, where reproductive rights are under constant attack, it is critical to remove barriers and ensure broad access to contraception,” Rodriguez said. “We need providers to follow this prescribing practice as their default practice and for patients to know it is their right to request it.”