WOMEN'S HEALTH
July 18, 2019

A Year of Birth Control

When veterans were given a year's supply of oral contraceptives, instead of 90 days, the risk and costs of unplanned pregnancies went down.

It's not uncommon for people to forget to refill their prescriptions until they have used the last pill or capsule and run out. When the prescription is for birth control pills, or oral contraceptives (OCs), the risk of an unplanned pregnancy goes up.

The Veterans Administration (VA) provides care to female veterans that includes covering the cost of birth control pills. Most women covered by the VA receive a 90-day supply of oral contraceptives per prescription refill. Yet VA data show that 43 percent of women receiving a 90-day supply have at least one delay in refills every year.

To date, 17 states and the District of Columbia have passed laws requiring insurers to cover a 12-month supply of birth control pills.

Delays in prescription refills can reduce the effectiveness of oral contraceptives, so it makes sense that women who receive a 12-month supply of OCs up front will have fewer unintended pregnancies.

Researchers from the University of Pittsburgh calculated the estimated financial and reproductive cost to the VA of implementing a 12-month dispensing policy and found that a 12-month dispensing policy would save the VA money by reducing the number of unintended pregnancies among female veterans.

Female veterans have a lot of mental and physical conditions like depression, anxiety or PTSD that are usually related to their service, Colleen Judge-Golden, lead author on the study, told TheDoctor. These mental health vulnerabilities make the negative consequences of unintended pregnancy that much harder on female veterans.

The VA doesn’t cover abortion care. “So we think it is important to enact policies that help women female veterans effectively prevent pregnancy, and maintain their reproductive autonomy,” Judge-Golden added.

To look at how the cost of dispensing a 12-month supply of oral contraceptives compared to the costs incurred under the current three-month limit, the researchers developed a mathematical model based on a group of over 24,000 women enrolled in the VA health system who wanted to avoid pregnancy for at least one year.

Judge-Golden and her team determined that by preventing 583 unwanted pregnancies, dispensing a 12-month supply of oral contraceptives would save the VA about $2.1 million per year in pregnancy, delivery and newborn care costs.

Health plans put the limit of a three-month supply in place to save money. Insurers want to avoid dispensing medication that will go unused. However, as Judge-Golden, an MD-PhD candidate at University of Pittsburgh School of Medicine explains, “The findings of our study show that concerns about wasting OCs could be outweighed by the consequences of missed refills, particularly unintended pregnancies.”

To date, 17 states and the District of Columbia have passed laws requiring insurers to cover a 12-month supply of birth control pills. Judge-Golden said, “One-year dispensing is definitely the minority, but there is a growing momentum among healthcare systems to offer full year dispensing, so I think we will be seeing more of that.”

The findings are being shared with VA women’s healthcare decision-makers. “The VA has striven to provide high quality women’s healthcare, so this is a great opportunity for the VA to continue setting a high standard,” said Judge-Golden.

The study and a related editorial are published in JAMA Internal Medicine.

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