ACA Mandate for Full Coverage of Oral Contraceptives Reduced Costs


Affordable Care Act mandate requires most oral contraceptives to be fully covered without cost-sharing.

A recent study examined how the Affordable Care Act revolutionized contraceptive coverage, and how the legislation affected usage.

Currently, oral contraceptives are the most common contraceptive used. However, approximately 41% of unintended pregnancies and increased out-of-pocket spending occurs as a result of inconsistent use. Under the Affordable Care Act mandate, a majority of commercial insurance plans are required to cover FDA-approved contraceptives without copays and deductibles.

In states such as Maryland, additional forms of contraceptives, such as Plan B, vasectomies, and female sterilization are fully covered. In a study published by Health Affairs, researchers examined how cost sharing and discontinuation or nonadherence of oral contraceptives were related.

Included in the study were insurance claims data for 635,075 women with employer-sponsored insurance who were taking generic or branded oral contraceptives. They discovered that more women were consistently using generic oral contraceptives after the implementation of the Affordable Care Act mandate.

Approximately 75% of women were not charged a deductible or a copay for generic oral contraceptives, and 54.9% of women did not pay for branded versions after the Affordable Care Act mandate, according to the study. The use of branded oral contraceptives was associated with decreased discontinuation, but researchers did not find a significant change in constancy of use.

Additional long-term studies need to be conducted to analyze the impact of the mandate on rates of contraceptive use, unintended pregnancy, and maternal and neonatal outcomes, the researchers found.

“Our study finds that cost-sharing does impact women’s ability to use pills as prescribed and that reducing cost-sharing, as achieved by the ACA, may help women use pills consistently,” said first author of the study Lydia E. Pace, MD, MPH. “Since the pill remains the most common contraceptive method, nonadherence among women seeking to avoid pregnancy is a critical public health concern and strategies to promote adherence could help reduce unintended pregnancies among women.”

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