title: Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods.
abstract: The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA's mandate has impacted long-acting reversible contraceptives (LARC) use is unknown.
  
  
  
  The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA's contraceptive mandate.
  
  
  
  A retrospective cohort study using Truven Health MarketScan claims data from January 2010 to December 2013.
  
  
  
  Women aged 18-45 years with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010-2013 (N=3,794,793).
  
  
  
  Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time after the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics.
  
  
  
  The proportion of claims with $0 cost-sharing for intrauterine devices and implants, respectively, rose from 36.6% and 9.3% in 2010 to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P<0.001). LARC uptake increased over time with no significant change in level of LARC use after ACA implementation in January 2013 (P=0.44) and a slightly slower rate of growth post-ACA than previously reported (β coefficient for trend, -0.004; P<0.001).
  
  
  
  The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.
authors.affiliation: *Department of Internal Medicine, Division of Women's Health, Brigham and Women's Hospital, Boston, MA †Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy ‡Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC §Department of Internal Medicine, Division of General Internal Medicine, Brigham and Women's Hospital ∥Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Lydia E
authors.initials: LE
authors.lastname: Pace
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000191:economics / Q000379:methods / Q000639:trends*; D003271:Contraceptive Agents, Female / Q000191:economics / Q000627:therapeutic use; D017047:Cost Sharing / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000331:legislation & jurisprudence; D065186:Interrupted Time Series Analysis; D007434:Intrauterine Devices / Q000191:economics / Q000639:trends; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female