Prescription Contraceptive Sales Following the Affordable Care Act.

Objectives We examine trends in prescription contraceptive sales following the Affordable Care Act's (ACA) zero-copayment contraceptive coverage mandate in areas more likely to be affected by the provision relative to areas less likely to be affected. Methods Before the ACA, several states had their own contraceptive insurance coverage mandates. Using a national prescription claims database combined with wholesaler institutional sales activity from January 2008 through June 2014, we compare sales of the intrauterine device (IUD), implant, injectable, pill, ring, and patch in states that had a state-level insurance coverage mandate before the ACA to states that did not. Results Overall, our results imply the ACA increased sales of prescription contraceptives, with stronger effects for some methods than others. Specifically, we find the ACA increased sales of injectable contraceptives, but had no significant impact on sales of the IUD, implant, pill, or patch in states without a state-level mandate before the ACA relative to states that had a state-level mandate. We also find suggestive evidence of a reduction in sales of the ring. Conclusions for Practice Demand responses to changes in out-of-pocket expenses for contraception vary across methods. Eliminating copays could promote the use of contraceptives, but is not the only approach to increasing contraceptive utilization.

The relationship between long-acting reversible contraception and insurance coverage: a retrospective analysis.

OBJECTIVE: The objective was to determine if there is a relationship between patients' financial responsibility (out-of-pocket expenses) and placement of long-acting, reversible contraceptive (LARC) methods among girls and women living in Appalachia who expressed interest in LARC device placement. STUDY DESIGN: A retrospective chart analysis of patients prescribed an intrauterine device (IUD) or an etonogestrel implant between December 2011 and July 2013 in an Appalachian private practice was performed. Of the 571 identified patients aged 13 to 50, the majority were Caucasian (98.7%) and using Medicaid (53.2%). Outcomes measured the patients' decision regarding whether to use LARC after being informed of out-of-pocket expenses. RESULTS: There was a dramatic increase in the proportion of patients who had LARC methods placed if expense was under $200 (p<.001). Placement rate for privately insured patients was 86.6% for those who paid less than $200 compared to 27.8% for those who paid $200 or more. Medicaid patients, for whom the device was free, had a 78.0% placement rate. For every additional $100 patients had to pay out of pocket, the odds of deciding to use the prescribed LARC method decreased. CONCLUSIONS: LARC methods are utilized significantly more often when out-of-pocket cost is low. Cost appears to be a significant barrier to device placement for the group of privately insured Appalachian patients with out-of-pocket expenses over $200. Despite the improvements in coverage for many women provided under the Affordable Care Act, cost may remain a barrier for privately insured women who are required to pay some or all of the cost of LARC methods. IMPLICATIONS: Unintended pregnancy rates in the United States remain high, especially in Appalachia. One contributing factor is reliance on user-dependent methods which have significantly high typical use failure rates. Placement of LARC methods for more patients could decrease unintended pregnancy, but device costs may be one barrier to utilization, even for those with private insurance.

Métodos contraceptivos reversíveis de longa duração no Sistema Único de Saúde: o debate sobre a (in)disciplina da mulher / Long-acting reversible contraception methods in the Brazilian Unified National Health System: the debate on women's (in)discipline

Resumo Recentemente a Federação Brasileira das Associações de Ginecologia e Obstetrícia submeteu ao Ministério da Saúde uma solicitação para oferta no Sistema Único de Saúde de métodos contraceptivos reversíveis de longa duração (LARC), para jovens mulheres de 15 a 19 anos. Os dois dispositivos a serem incluídos seriam o implante subdérmico liberador de etonogestrel, com duração de três anos, e o sistema intrauterino liberador de levonorgestrel, com duração de cinco anos. O Ministério da Saúde abriu então consulta pública para avaliar tal introdução, terminando por decidir contrariamente à inclusão destes métodos na rede pública de saúde. O artigo discute as estratégias discursivas utilizadas para fundamentar e justificar a aceitação e aplicabilidade destes métodos em "populações especiais". O debate sobre o planejamento reprodutivo precisa compreender melhor as descontinuidades contraceptivas no uso de métodos, a centralidade da contracepção de emergência e o quanto as hierarquias de gênero dificultam uma prática contraceptiva segura. Ao contrário, a ênfase na (in)disciplina da mulher no tocante aos cuidados com a utilização de métodos contraceptivos de uso regular termina por reforçar sua condição de menoridade social.

Abstract Recently, the Brazilian Federation of Gynecology and Obstetrics Associations submitted a request to the Brazilian Ministry of Health for an introduction of long-acting reversible contraception (LARC) methods for young women aged 15 to 19 years in the Brazilian Unified National Health System. The two devices to be included were the etonogestrel-releasing subdermal implant (ENG implant), with a duration of three years, and the levonorgestrel-releasing intrauterine system (LNG-IUS), lasting five years. The Ministry of Health then launched a public inquiry to evaluate this introduction, deciding against the inclusion of these methods in the public health services. The article discusses the discursive strategies used to justify the acceptance and applicability of these methods in "special populations." The debate on family planning needs to understand fully the discontinuity of contraception in the use of such methods, the central concept of emergency contraception, and how gender hierarchies prejudice safe contraceptive practice. On the contrary, the emphasis on the (in)discipline of women regarding care with regular-use contraceptive methods effectively reinforces their condition of social minority.