Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing

Becker, Nora; Polsky, Daniel

doi:10.1377/hlthaff.2015.0127

Cited by 71 publications

(44 citation statements)

References 20 publications

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“…Consistent with a recent study from a single large insurance carrier, 8 our findings demonstrate that implementation of the ACA has had substantial impact on cost-sharing for LARC for women with employer-sponsored commercial insurance, in particular dramatically increasing the proportion of women with $0 cost-sharing for LARC insertions. In interrupted time series analyses adjusting for patient and plan characteristics, rates of LARC use in our population rose steadily from 2010–2013, consistent with findings from a national survey that has shown steady increases from 2009–2012.…”

Section: Discussionsupporting

confidence: 89%

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Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods

2016

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Background The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA’s mandate has impacted long-acting reversible contraceptives (LARC) use is unknown. Objective The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA’s contraceptive mandate. Design Retrospective cohort study using Truven Health MarketScan claims data from January 2010–December 2013. Subjects Women aged 18–45 with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010–2013 (N=3,794,793). Measures Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time following the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics. Results The proportion of claims with $0 cost-sharing for IUDs and implants, respectively, rose from 36.6% and 9.3% in 2010, to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P<.001). LARC uptake increased over time with no significant change in level of LARC use post-ACA implementation in January 2013 (P=0.44) and a slightly slower rate of growth post-ACA than previously (beta coefficient for trend: −0.004, p<0.001). Conclusions The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.

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Section: Discussionsupporting

confidence: 89%

“…5, 6 Despite some variability across method types, 6 evidence suggests that the ACA’s mandate overall translated into substantial reductions in cost-sharing for women in 2013. 7, 8 …”

Section: Introductionmentioning

confidence: 99%

Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods

2016

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“…Women who choose pills, patch, or ring are also often required to refill prescriptions at frequent intervals and these methods plus injections require women to manage use (e.g., taking a pill, changing a patch or ring, returning to the provider for the next injection). In addition, out-of-pocket costs across such methods average $9/month (Becker & Polsky, 2015). …”

mentioning

confidence: 99%

Using behavioral economic theory to increase use of effective contraceptives among opioid-maintained women at risk of unintended pregnancy

Heil

Hand

Sigmon

et al. 2016

Preventive Medicine

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Objective An unsettling aspect of the US opioid epidemic is the high rate of in utero exposure, especially since most of these pregnancies are unintended, due in part to low rates of effective contraceptive use among opioid-using women. This study tested an intervention informed by behavioral economic theory and aimed at promoting effective contraceptive use among opioid-maintained women at risk of unintended pregnancy in the Burlington, VT area between 2011–2013. Methods Thirty-one women were assigned (initial 5 consecutively, subsequent 26 randomly) to either usual care or an experimental intervention. Participants in usual care received condoms, a dose of emergency contraception, and referral to local providers. Participants in the experimental condition received usual care plus the World Health Organization’s contraception initiation protocol, including free prescription contraceptives, and financial incentives for attending 13 follow-up visits over 6 months to help manage side effects and other issues. Results Significantly more women in the experimental vs. usual care control conditions initiated prescription contraceptive use (100% vs. 29%) and reported prescription contraceptive use at 1-month (63% vs. 13%), 3-month (88% vs. 20%), and 6-month (94% vs. 13%) assessments. None of the experimental condition participants became pregnant during the 6-month protocol vs. three women (20%) in the control condition. Conclusions These results provide the first experimental evidence supporting the efficacy of an intervention for increasing prescription contraceptive use among opioid-maintained women at risk of unintended pregnancy.

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“…The roles of insurance coverage, co-pays, method cost-sharing, and confidentiality concerns with parental and school-based plans for younger women have received significant attention in light of the Affordable Care Act (ACA) [32,33]. Studies on the ACA and reproductive health have found that young women lack awareness and understanding of the ACA, family planning provisions under it, and even details of their own insurance plans [32].…”

Section: Discussionmentioning

confidence: 99%

“I don't know enough to feel comfortable using them:” Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus

et al. 2016

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Objective To assess multiple dimensions of long acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. Study Design We conducted an internet-based study of 1,982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women’s understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems, and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate, and linear regression statistics. Results Few college women had used (5%) or heard of (22%) LARC, and most self-reported “little” or “no” knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0–20), and scores differed across sociodemographic groups (p-values<0.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation, and contraceptive history. Perceived barriers to IUDs included: not wanting a foreign object in body (44%); not knowing enough about the method (42%); preferring a “controllable” method (42%); cost (27%); and not being in a long-term relationship (23%). Implant results were similar. “Not knowing enough” was women’s primary reason for IUD (18%) and implant (22%) nonuse. Conclusion Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual, systems, and community-level factors precluding these college women’s LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability, and uptake of LARC on campuses.

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Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing

Cited by 71 publications

References 20 publications

Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods

Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods

Using behavioral economic theory to increase use of effective contraceptives among opioid-maintained women at risk of unintended pregnancy

“I don't know enough to feel comfortable using them:” Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus

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