Each semester, Sarah Prager, MD, runs through a familiar yet arduous routine: trying to prescribe a 6- to 12-month supply of oral contraceptives for her college student patients. For those young women who study abroad for one or two semesters, the usual 1-month or 3-month supply won’t be enough.
“I even had two patients who had unplanned pregnancies while studying abroad for this very reason,” said Dr. Prager , associate professor of obstetrics and gynecology at the University of Washington, Seattle. “It’s previously been a real challenge to write the letters, and it takes an absurd amount of time to even fail at getting them 6 months, or to make a plan for them to travel some place to get them.”
But soon, those barriers won’t exist in Washington because of a new state law . Starting Jan. 1, 2018, new or renewed health plans that include contraceptive coverage must provide reimbursement for a 12-month supply of Food and Drug Administration–approved contraceptive pills, patches, and rings.
This type of policy has been in effect in California since Jan. 1, 2017, and a new study estimates that the measure will save the state nearly $43 million in health care costs while preventing thousands of unintended pregnancies, miscarriages, and abortions ( Contraception. 2017 May;95[5]:449-51 ).
“Awareness of this change in policy will be key in determining how much of an impact it will have,” said Sara McMenamin, PhD, MPH, assistant professor of public health at the University of California, San Diego, and the study’s lead author.
Dr. McMenamin and her colleagues project that 38% of current users of the contraceptive pill, patch, and ring will begin receiving 12-month prescriptions at a time, leading to 15,000 fewer unintended pregnancies, 2,000 fewer miscarriages, and 7,000 fewer abortions every year. Health care costs would be reduced by 0.03%, translating to approximately $42.8 million annually.
The single drawback noted in the study is increased pill waste by women who no longer prefer that contraceptive method or want to try to conceive, though the costs of increased waste are figured into the 0.3% cost savings. “It takes a lot of wasted pills to make up for the cost of one unintended pregnancy, especially if there are complications or adverse outcomes, which are more likely with unintended pregnancies,” Dr. McMenamin said.
There are potential environmental concerns to pill wastage as well, such as keeping it out of river systems and drinking water, Dr. Prager noted.
The California law’s effects will not happen immediately, so there may be a delay in reaching the study’s projections. “These results likely represent an overestimation in the short term, as it will likely take some time to change provider and patient behavior and increase awareness of the new policy,” Dr. McMenamin said.
But the idea is catching on. In 2016, Oregon, Hawaii, Illinois, Maryland, Vermont, and the District of Columbia enacted legislation requiring insurers to cover extended supplies of contraception. Since then, Washington state, Colorado, Virginia, and Nevada have approved similar laws and more than a dozen other states have introduced similar legislation.
Importantly, the effects of this type of coverage cut across demographics, Dr. Prager said.
“I think there’s this perception by many that these are challenges experienced by women who are underresourced or poor or teenagers, and they’re not,” Dr. Prager said. “People are busy, and it’s rare for working adults to have to think about getting to a pharmacy on a regular basis. Contraception is the exception.”
In addition, some women may experience coverage gaps that prevent refills during a job change or other insurance change. Women who travel a lot, for college or work, can have a harder time getting their refills, as well. And women in rural areas may need to drive up to an hour for a pharmacy.
“These are real-life concerns for people of all socioeconomic strata of all ages,” Dr. Prager said. “If you’re off by even a day, then a woman is at risk of pregnancy.”
The California study was supported by the California Health Benefits Review Program. Dr. Prager reported being an unpaid trainer for Nexplanon (Merck).
