title: A comparison of contraceptive procurement pre- and post-benefit change.
abstract: BACKGROUND
  In 2002, the Kaiser Foundation Health Plan in California changed its coverage policy to include 100% universal coverage for the most effective forms of contraception and for emergency contraceptive pills (ECPs). This study sought to evaluate whether removing the cost of contraception as a potential barrier to utilization would lead to a change in the mix of contraceptive methods prescribed and purchased by a large health plan and whether those changes could theoretically result in averting a greater number of unintended pregnancies.
  
  
  METHODS
  A retrospective observational study was conducted to describe the mix of reversible contraceptives procured before and after the benefit change at Kaiser Permanente Northern California. We then estimated couple-years of protection (CYP) to examine whether the contraceptive mix changed to more effective reversible methods.
  
  
  RESULTS
  After the contraceptive benefit change, CYP increased by 28% (from 2001-2002 to 2003-2004), while the number of females aged 15-44 enrolled in this health plan fell by 1%. CYP for intrauterine contraceptives (IUCs) and injectables rose by 137% and 32%, respectively, while CYP for the pill, patch and ring rose only by 16%. The estimated average annual contraceptive failure rate among women using hormonal contraceptives and IUCs declined from 7.0% to 6.4%. Purchasing of the ECP rose by 88%.
  
  
  CONCLUSIONS
  Removal of the cost of contraception may result in increased utilization of more effective methods and ECPs.
authors.affiliation: Kaiser Permanente, Northern California, Women's Health Research Institute, Oakland, CA 94612, USA. debbie.a.postlethwaite@kp.org
authors.forename: Debbie
authors.initials: D
authors.lastname: Postlethwaite
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.forename: Anthony
authors.initials: A
authors.lastname: Zoolakis
authors.forename: Ruth
authors.initials: R
authors.lastname: Shabear
authors.forename: Diana
authors.initials: D
authors.lastname: Petitti
mesh_terms: D003271:Contraceptive Agents, Female / Q000191:economics* / Q000600:supply & distribution; D003274:Contraceptive Devices, Female / Q000191:economics* / Q000706:statistics & numerical data / Q000600:supply & distribution; D005260:Female; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D008329:Managed Care Programs / Q000706:statistics & numerical data; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies
chemical_list: D003271:Contraceptive Agents, Female