Policies implementation linked to increased 12-month contraception coverage

Policies implementation linked to increased 12-month contraception coverage: © (JLco) Julia Amaral - stock.adobe.com

There is a link between a 12-month contraceptive supply policy and a slight increase in the rate of contraception dispensing through a 12-month or longer supply among Medicaid recipients using short-acting hormonal contraception, according to a recent study published in JAMA Health Forum.¹

Currently, the oral contraceptive pill remains the most common method of contraception among US individuals, with 99% efficacy reported with perfect use.² However, breaks in contraceptive use lead to decreased efficacy, indicating a need for methods such as a 6- to 12-month supply of pills to prevent breaks in coverage.¹

Data has indicated 70% of US short-acting contraceptive users receive a supply of 3 months or less. Policies supporting a 12-month contraceptive supply may reduce this rate, but more data about the efficacy of these policies is needed.

Investigators conducted a study to evaluate the efficacy of a 12-month contraceptive supply policy toward increasing continuous contraceptive use. National Medicaid claims and enrollment data from 2016 to 2020 in both treatment and comparison states were included in the analysis.

Treatment states were considered those with Medicaid legislation for a 12-month contraceptive supply with compliance dates from January 1, 2016, to December 31, 2020. The prepolicy period was from January 1, 2016, to the compliance date, while the postpolicy period was from the compliance date to December 31, 2020.

States without a 12-month contraceptive supply policy before December 31, 2020, were considered comparison states. There were 36 states included in the final analysis, 11 of which were treatment states and 25 were comparison states. Participants included women aged 18 to 44 years enrolled in Medicaid during the study period. 

Investigators defined the primary outcomes of the analysis as, “the proportion of total months of contraception supplied during a state-quarter, provided in a single 12-month or longer supply fill.” The proportion was also reported as part of a 2- to 3-month supply fill as the secondary outcome.

There were 4,778,264 participants included in the final analysis. Across both treatment and comparison states, these participants primarily used oral contraceptive pills. In comparison states, 82.73% of months of contraception were received through a 1-month supply in the first quarter, vs 51.40% of the final quarter.

The rates of 1-month contraceptive supply in the first and final quarter were 58.10% and 31.23%, respectively, in treatment states. Additionally, the rate of 2- to 3-month supply receipt rose by 19.36% in treatment states and 31.34% in comparison states.

Comparison states had an insignificant amount of 12-month supply receipts during the study period, at 0.01% in the first quarter and 0.02% in the final quarter. These receipts were also minimal during the first quarter in the treatment group at 0.11% but increased to 6.16% by the final quarter.

Policy implementation was associated with a 12-month or longer supply fill increase of 4.39%. However, no association was reported between policy implementation and a change in 2- to 3-month contraceptive supply dispensing.

These results indicated increased rates of 12-month or longer contraceptive supply from implementing policies mandating 12-month coverage. Investigators recommended federal policy mandating 12-month coverage to support contraceptive access.

References

1. Rodriguez MI, Meath THA, Daly A, Watson K, McConnell KJ, Kim H. Twelve-month contraceptive supply policies and Medicaid contraceptive dispensing. JAMA Health Forum. 2024;5(8):e242755. doi:10.1001/jamahealthforum.2024.2755

2. Hatcher RA. Contraceptive Technology. 21st edition. Managing Contraception LLC. 2018:874.