Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Health Care System

Abstract

IMPORTANCE The Veterans Affairs (VA) health care system is the largest integrated health care system in the United States. Like most US health plans, the VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). However, 12-month OCP dispensing has been shown to improve continuation of use, decrease coverage gaps, and reduce unintended pregnancy in other practice settings. OBJECTIVE To estimate the financial and reproductive health implications for the VA of implementing a 12-month OCP dispensing option, with the goal of informing policy change. DESIGN, SETTING, AND PARTICIPANTS A decision model from the VA payer perspective was developed to estimate incremental costs to the health care system of allowing the option to receive a 12-month supply of OCPs up front, compared with the standard 3-month maximum, during a 1-year time horizon. A model cohort of 24 309 reproductive-aged, heterosexually active, female VA enrollees who wish to avoid pregnancy for at least 1 year was assumed. Probabilities of continuation of OCP use, coverage gaps, pregnancy, and pregnancy outcomes were drawn from published data. Costs of OCP provision and pregnancy-related care and the number of women using OCPs were drawn from VA administrative data. One-way and probabilistic sensitivity analyses were performed to assess model robustness. MAIN OUTCOMES AND MEASURES Incremental per-woman and total costs to the VA of allowing for 12-month dispensing of OCPs compared with standard 3-month dispensing. RESULTS The 12-month OCP dispensing option, modeled from the VA health system perspective using a cohort of 24 309 women, resulted in anticipated VA annual cost savings of $87.12 per woman compared with the cost of 3-month dispensing, or an estimated total savings of $2 117 800 annually. Cost savings resulted from an absolute reduction of 24 unintended pregnancies per 1000 women per year with 12-month dispensing, or 583 unintended pregnancies averted annually. Expected cost savings with 12-month dispensing were sensitive to changes in the probability of OCP coverage gaps with 3-month dispensing, the probability of pregnancy during coverage gaps, and the proportion of pregnancies paid for by the VA. When simultaneously varying all variables across plausible ranges, the 12-month strategy was cost saving in 95.4% of model iterations. CONCLUSIONS AND RELEVANCE Adoption of a 12-month OCP dispensing option is expected to produce substantial cost savings for the VA while better supporting reproductive autonomy and reducing unintended pregnancy among women veterans.

Twelve month oral contraceptive pill prescriptions: Role of policy mandates on utilization

“…Moreover, Judge-Golden et al's economic decision model suggest a favorable economic outcome if 12-month duration dispensing is used compared to 3-months. 6 In that study, the authors modelled 24,309 women in reproductive age within the VA system. Relying on improved continuity of use and reduced unintended pregnancies of 12-month extended duration packs, the model suggested $87 per woman per year savings for the VA health system.…”

“… 3 , 4 , 5 Subsequently, some researchers and advocacy groups have advanced the need for insurance policies that allow for prescribing and dispensing of OCP multi-packs beyond three-month duration by third-party payers and dispensers. 6 , 7 As of 2019, there were 17 states and Washington DC with policies mandating health plans to provide at least six-month duration dispensing as an option for women. 8…”

Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas

“…Expanding routine care beyond one or two postpartum visits and instituting regular provider follow-up would facilitate continuation or switching, as would connecting uninsured women to family planning programs and advising them on low-cost prescription resources. Additionally, changing short-acting hormonal dispensing protocols to offer a greater supply, moving them over-the-counter and widely offering self-administration of the injectable could expand access and increase continuation [ [23] , [24] , [25] , [26] ]. These changes would likely be beneficial to postpartum women who may be especially burdened by the logistical demands of seeking refills.…”

The unequal distribution of administrative burden: A framework and an illustrative case study for understanding variation in people's experience of burdens

“…There are, however, a few administrative requirements for enrollment. These may be important, since research suggests that even apparently low burdens can already have a significant impact on take‐up (Judge‐Golden, Smith, Mor, & Borrero, 2019). Children and parents must have an official identity document (DNI—for Documento Nacional de Identidad ), which is provided by the National Registry of Persons (RENAPER).…”