About 43 million American women are at risk of unintended pregnancy. Of them, 12.4 million use birth control pills, patches, or vaginal rings - all hormonal, prescription methods which generally require monthly patient refill, and are reliant on the user’s continuous use from month to month in order to avoid risk of unintended pregnancy.
However, women face huge obstacles to continuation of contraceptive methods in order to avoid unintended pregnancy. In particular, there is a high monthly burden of time, cost, and energy expenditures required of women in order to refill and pick up these prescriptions month after month - especially for women who work hourly-wage jobs, do not have access to reliable transportation, live in rural areas, or already have children. It is clear that providing women a longer supply of their contraceptive methods leads to greater continuation of the methods, fewer unintended pregnancies, and less cost per client - outcomes that are positive for women, healthcare professionals, and health insurance companies alike.
Giving women access to extended supplies of contraceptives can addressed through a two-pronged approach: state or federal policies that allow for prescriptions of one-year supplies of birth control, coupled with thorough education for providers on this policy change.
Women who receive a one-year supply of their preferred method of birth control have been found to be 30% less likely to experience unintended pregnancy compared to women receiving a one to three-month supply. However, dispensing patterns currently vary by state and insurer, with most insurance plans limiting prescriptions to one or three-month periods, and most states doing nothing to change this. While laws requiring insurer coverage for 12 month-supplies of oral contraceptives have been enacted in twelve states and the District of Columbia since 2015, some states have experienced a lack of utilization of these new policies due to lack of provider awareness of the laws.
In the case of Oregon’s 2015 roll-out of this policy, for example, many healthcare providers, pharmacists, and health insurance companies were unaware of the new law or did not have time to update their internal technology systems to allow automatic approval of 12-month birth control prescriptions; in the case of one insurance company, it took 11 months from the time the law took effect in January 2015 to update their systems to prevent disapprovals for these prescriptions. And of course, certain insurance plans were exempt from the law, including federal insurance plans like Tricare and Oregon Health Plan, whose client base of low-income women is arguably the demographic group most likely to benefit from this policy. According to Oregon Public Broadcasting, Oregon’s Department of Consumer and Business Services received so many complaints in 2016 that it issued a bulletin, a full year after the law went into effect, to remind insurers of their obligations and the penalties for lack of compliance under the Oregon Insurance Code.
It was suggested to Oregonian women seeking these prescriptions that they may need to educate their providers, pharmacists, and insurance companies about the law. This is hardly a solution, particularly given that this law was specifically designed to reduce the burden on women of receiving their contraceptive prescriptions. Passing policies that allow for 12-month supplies of contraceptives is the first step towards addressing the public health problem generated by allowing for only short-term supplies of contraceptives; however, these policies are ineffective without ensuring thorough education for providers, pharmacists, and insurance companies on their benefits.
Some states have enacted solutions outside of 12-month prescriptions to expand contraceptive access, including allowing birth control to be sold over the counter, or allowing patients to obtain prescriptions from pharmacists, online services, or smartphone applications without first requiring an in-person visit to a physician. However, each of these solutions has run into complications in practice, ranging from minimum age requirements for prescriptions, limits on the type of contraceptives that pharmacists can prescribe, and if the patient needs a prior visit to or prescription from a physician. While policies that allow for 12-month supplies of birth control have also proven to be imperfect, they are, in my opinion, the simplest route to ensuring continuation of contraceptive method.
References:
Foster, D., Hulett, D., Bradsberry, M., Darney, P. and Policar, M. (2011). Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies. Obstetrics & Gynecology, [online] 117(3), pp.566-572. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21343759
Guttmacher Institute. (2017). Contraceptive Use in the United States. [online] Available at: https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
Guttmacher Institute. (2017). Moving Oral Contraceptives to Over-the-Counter Status: Policy Versus Politics. [online] Available at: https://www.guttmacher.org/gpr/2015/11/moving-oral-contraceptives-over-counter-status-policy-versus-politics
Lehman (2017). Insurers To Get Reminder About Oregon's Prescription Birth Control Law. [online] Opb.org. Available at: http://www.opb.org/news/article/oregon-prescription-birth-control-law-insurers-reminders/
Portland Monthly. (2017). Are Oregon’s New Birth Control Laws Actually Helping Anyone?. [online] Available at: https://www.pdxmonthly.com/articles/2017/1/4/are-oregons-new-birth-control-laws-actually-helping-anyone
PPAoregon.org. (2017). Did You Know That Oregon Law Guarantees a Full Year of Birth Control? | Planned Parenthood Advocates of Oregon. [online] Available at: https://www.ppaoregon.org/2017/06/05/did-you-know-oregon-law-guarantees-full-year-birth/
Steenland, M., Rodriguez, M., Marchbanks, P. and Curtis, K. (2013). How does the number of oral contraceptive pill packs dispensed or prescribed affect continuation and other measures of consistent and correct use? A systematic review. Contraception, [online] 87(5), pp.605-610. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23040121
The Henry J. Kaiser Family Foundation. (2017). Oral Contraceptive Pills. [online] Available at: https://www.kff.org/womens-health-policy/fact-sheet/oral-contraceptive-pills/