Early Impact Of The Affordable Care Act On Oral Contraceptive Cost Sharing, Discontinuation, And Nonadherence.
The oral contraceptive pill is the contraceptive method most commonly used by US women, but inconsistent use of the pill is a contributor to high rates of unintended pregnancy. The relationship between consumer cost sharing and consistent use of the pill is not well understood, and the impact of the elimination of cost sharing for oral contraceptive pills in a mandate in the Affordable Care Act (ACA) is not yet known. We analyzed insurance claims for 635,075 women with employer-sponsored insurance who were initiating use of the pill, to examine rates of discontinuation and nonadherence, their relationship with cost sharing, and trends before and during the first year after implementation of the ACA mandate. We found that cost sharing for oral contraceptives decreased markedly following implementation, more significantly for generic than for brand-name versions. Higher copays were associated with greater discontinuation of and nonadherence to generic pills than was the case with zero copayments. Discontinuation of the use of generic or brand-name pills decreased slightly but significantly following ACA implementation, as did nonadherence to brand-name pills. Our findings suggest a modest early impact of the ACA on improving consistent use of oral contraceptives among women initiating their use.
Lydia E. Pace (lepace@partners.org) is an associate physician in the Division of Women's Health at Brigham and Women's Hospital and an instructor in medicine at Harvard Medical School, both in Boston, Massachusetts.
Lydia E
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Pace
Stacie B. Dusetzina is an assistant professor of pharmacy and public health in the Eshelman School of Pharmacy and the Gillings School of Public Health, both at the University of North Carolina at Chapel Hill.
Stacie B
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Dusetzina
Nancy L. Keating is a professor of health care policy and medicine in the Department of Health Care Policy at Harvard Medical School and the Division of General Internal Medicine at Brigham and Women's Hospital.
Nancy L
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Keating
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000191:economics*; D017047:Cost Sharing; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D011247:Pregnancy; D014481:United States; D028761:Withholding Treatment / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
D003271:Contraceptive Agents, Female
Affordable Care Act; adherence; contraception; discontinuation; oral contraceptive pills