The impact of out-of-pocket expense on IUD utilization among women with private insurance

Abstract

Background The study was conducted to evaluate the impact of out-of-pocket expense on intrauterine device (IUD) utilization among women with private insurance. Study Design We reviewed the records of all women with private insurance who requested an IUD for contraception from an urban academic gynecology practice from May 2007 through April 2008. For each patient, we determined the out-of-pocket expense that would be incurred, and whether she ultimately had an IUD placed. The total charge for placement of a copper or levonorgestrel IUD (including the device) was $815. Results Ninety-five women requested an IUD during the study period. The distribution of out-of-pocket expense was bimodal: less than $50 for 35 (37%) women and greater than $500 for 52 (55%) women. IUD insertion occurred in 24 (25%) women, 19 of whom had an out-of-pocket expense less than $50. In univariate and multivariable analysis, women with insurance coverage that resulted in less than $50 out-of-pocket expense for the IUD were more likely to have an IUD placed than women required to pay $50 or more (adjusted OR=11.4, 95% CI = 3.6, 36.6),. Conclusions Women requesting an IUD for contraception are significantly more likely to have an IUD placed when out-of-pocket expense is less than $50.

Barriers to Receiving Long-acting Reversible Contraception in the Postpartum Period

“…In a recent review of barriers for adolescents interested in LARC, reported mean out-of-pocket expenses for those without insurance for a LARC device and insertion exceeded $1,000 (Eisenberg, McNicholas, & Peipert, 2013). Another analysis found that in patients with insurance coverage, the amount of copays can profoundly decrease rates of obtaining an IUD, because those with copays that exceeded $50 were 11 times less likely to obtain an IUD (Gariepy, Simon, Patel, Creinin, & Schwarz, 2011). The Contraceptive Choice Project, although not focused on a postpartum population, has achieved greater than 75% LARC usage rates by eliminating nearly every barrier mentioned by participants in this study (Secura, Allsworth, Madden, Mullersman, & Peipert, 2010) and other published reports from the Contraceptive Choice Project cohort has demonstrated LARC's cost effectiveness (Winner et.…”

Differences in contraceptive use between family planning providers and the U.S. population: results of a nationwide survey

“…Though not measured directly in this study, cost and access may also contribute to differences in providers' and patients' contraceptive choices. LARC uptake has been shown to increase when cost barriers are removed or reduced [17,18]. This survey was conducted in 2013, shortly after a provision of the Affordable Care Act (ACA) granted privately insured women access to birth control with no out-of-pocket costs.…”

The Impact of Out-of-Pocket Costs on the Use of Intrauterine Contraception Among Women With Employer-sponsored Insurance

“…13,14 LARC methods often entail high initial costs, including for privately insured women, 15 and some data suggest that higher costsharing is a deterrent to LARC use. 6,16,17 However, other major barriers to LARC use exist in the United States, including patient and provider knowledge and attitudes regarding contraception in general and IUDs in particular. 18 Existing data are insufficient to accurately predict the impact of out-ofpocket cost elimination on LARC use nationally.…”