Researchers Discover Low Uptake of 12-Month Contraceptive Supply Policies in U.S. States
Researchers at Oregon Health & Science University have revealed that even though 19 states in the U.S. have laws mandating insurers to provide a 12-month supply of contraceptives, most patients end up receiving far less, typically just three months or even fewer.
A recent study published in the journal JAMA Health Forum indicates that the policies requiring coverage for a 12-month supply of short-acting hormonal contraception—predominantly the birth control pill—are not being effectively executed. Consequently, there has been no notable increase in the number of patients receiving year-long prescriptions, which raises the likelihood of unintended pregnancies.
One common reason for the reduced effectiveness of the pill is inconsistent use, often caused by running out of medication or delays in obtaining refills. However, providing a longer-term supply of contraception, whether for six or twelve months, has been associated with better continuous use, fewer interruptions, and cost savings for healthcare systems.
“The choice of when to become a parent is highly personal,” stated Maria Rodriguez, M.D., M.P.H., a professor of obstetrics and gynecology at OHSU and the director of the OHSU Center for Reproductive Health Equity. “It shouldn’t be influenced by complications retrieving a refill at the pharmacy or when a pill pack runs out during a vacation.”
To tackle these challenges, lawmakers in 19 states have implemented policies mandating a 12-month contraceptive supply, obligating insurers to cover the cost of a full year’s worth of prescriptions at once. However, research from OHSU indicates that these policies have not been effectively applied, and there has been little change in prescribing behavior.
By utilizing a difference-in-difference analysis to assess changes in prescription outcomes over time, researchers examined contraception prescriptions (oral pills, patches, and rings) among nearly 4.8 million women enrolled in Medicaid, ages 18 to 44, across 36 states—11 with the 12-month supply legislation and 25 without. Findings showed that in 10 of the 11 states with the policy, the increase in the proportion of contraceptives dispensed was less than one percentage point, indicating minimal improvement in long-term prescriptions.
“Our results highlight a significant lack of awareness among patients and prescribers, and we hope these findings encourage action to establish 12-month supplies as a standard in prescribing practices,” said Rodriguez. “This represents an easy opportunity to enhance access to birth control, especially for those living in states with stricter reproductive healthcare regulations.”
For these coverage policies to succeed, insurance providers must adhere to the updated guidelines and be held accountable, Rodriguez noted. Furthermore, healthcare providers need to adjust their prescribing habits to favor extended supplies of contraception, while pharmacists will need to accommodate this by dispensing the full supply.
The research team asserts that fully implementing these policies will necessitate outreach to individuals using contraception, to prescribers, pharmacists, and insurers, alongside enforcement from state governments. Additionally, a federal policy that requires coverage of a 12-month supply could enhance access since it would make this requirement applicable to all insurers, including private ones.
Rodriguez encourages patients to feel empowered to inquire about their contraceptive options and to advocate for methods that align with their personal choices, lifestyles, and family planning goals.
“In a healthcare landscape where reproductive rights are frequently challenged, it’s essential to eliminate barriers and ensure widespread access to contraception,” Rodriguez stressed. “We need providers to adopt this prescribing approach as the norm and for patients to recognize that they have the right to request it.”
