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Early impact of the affordable care act on oral contraceptive cost sharing

September 07, 2016

Oral contraceptives are the most commonly used contraceptive method in the United States. Forty-one percent of unintended pregnancies are estimated to occur in women using contraception inconsistently. When the pill is not taken as prescribed, or usage is stopped, the likelihood of unintended pregnancies increases, and patient surveys suggest that higher out-of pocket spending for contraceptives may contribute to inconsistent use.

In a new study, published in the Sept. 2016 issue of Health Affairs, Brigham and Women's Hospital researchers examined how the Affordable Care Act (ACA) mandate requiring most commercial insurance plans to cover Food and Drug Administration (FDA) approved contraceptive methods, without cost sharing (co-pays and deductibles), has impacted oral contraceptive use. Researchers looked at the relationship between cost sharing and discontinuation and nonadherence of oral contraceptives among women with employer sponsored insurance by analyzing insurance claims data for 635,075 women who were using brand name or generic versions of the pill.

Researchers found that implementation of the ACA's contraceptive mandate was associated with more consistent use of generic pills. About 75 percent of women paid nothing out of pocket (no deductible or co-pay) for generic pills following the implementation of the mandate, compared to 54.9 percent of claims for brand name pills. For brand-name pills, the implementation of the ACA mandate was associated with reduced levels of discontinuation, but among those who continued usage, no significant change was noted in consistency of use.

"Our study finds that cost-sharing does impact women's ability to use pills as prescribed and that reducing cost-sharing, as achieved by the ACA, may help women use pills consistently," said Lydia E. Pace, MD, MPH, associate physician, Division of Women's Health, Brigham and Women's Hospital and first author of the study. "Since the pill remains the most common contraceptive method, nonadherence among women seeking to avoid pregnancy is a critical public health concern and strategies to promote adherence could help reduce unintended pregnancies among women."

Researchers note that longer-term evaluations should examine the impact of the ACA mandate on overall rates of contraceptive use and unintended pregnancy, and on maternal and neonatal outcomes.
This study was supported by the Mary Ann Tynan Fellowship in Women's Health and the Eleanor and Miles Shore Scholars in Medicine Program; the National Institutes for Health's Building Interdisciplinary Research Careers in Women's Health K12 Program and the North Carolina Translational and Clinical Sciences Institute grant No. UL1TR001111.

Brigham and Women's Hospital

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