Prescription Contraceptive Sales Following the Affordable Care Act
Objectives We examine trends in prescription contraceptive sales following the Affordable Care Act’s (ACA) zero-copayment contraceptive coverage mandate in areas more likely to be affected by the provision relative to areas less likely to be affected. Methods Before the ACA, several states had their own contraceptive insurance coverage mandates. Using a national prescription claims database combined with wholesaler institutional sales activity from January 2008 through June 2014, we compare sales of the intrauterine device (IUD), implant, injectable, pill, ring, and patch in states that had a state-level insurance coverage mandate before the ACA to states that did not. Results Overall, our results imply the ACA increased sales of prescription contraceptives, with stronger effects for some methods than others. Specifically, we find the ACA increased sales of injectable contraceptives, but had no significant impact on sales of the IUD, implant, pill, or patch in states without a state-level mandate before the ACA relative to states that had a state-level mandate. We also find suggestive evidence of a reduction in sales of the ring. Conclusions for Practice Demand responses to changes in out-of-pocket expenses for contraception vary across methods. Eliminating copays could promote the use of contraceptives, but is not the only approach to increasing contraceptive utilization.
KeywordsPrescription contraceptives Affordable Care Act LARC methods
Compliance with Ethical Standards
Conflict of interest
No conflicts of interest.
- Ananat, E. O., & Hungerman, D. M. (2012). The power of the pill for the next generation: Oral contraception’s effects on fertility, abortion, and maternal & child characteristics. The Review of Economics and Statistics, 94(1), 37–51. https://doi.org/10.1162/REST_a_00230.CrossRefPubMedPubMedCentralGoogle Scholar
- Branum, A. M., & Jones, J. (2015). Trends in long-acting reversible contraceptive use among U.S. women aged 15–44. (NCHS Data Brief No. No. 188) (pp. 1–7). Hyattsville, MD: Centers for Disease Control and Prevention National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db188.pdf.
- Chuang, C. H., Mitchell, J. L., Velott, D. L., Legro, R. S., Lehman, E. B., Confer, L., & Weisman, C. S. (2015). Women’s awareness of their contraceptive benefits under the patient protection and Affordable Care Act. American Journal of Public Health, 105(S5), S713–S715. https://doi.org/10.2105/AJPH.2015.302829.CrossRefPubMedPubMedCentralGoogle Scholar
- Daniels, K., Daugherty, J., & Jones, J. (2014). Current Contraceptive Status Among Women Aged 15–44: United States, 2011–2013 (NCHS Data Brief No. 173). Hyattsville, MD: National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db173.pdf?utm_source=Master+List&utm_campaign=c7a6b2971d-12_12_14_NIC_NSFG_LARC12_12_2014&utm_medium=email&utm_term=0_9ac83dc920-c7a6b2971d-244277089.
- Fleming, K. L., Sokoloff, A., & Raine, T. R. (2010). Attitudes and beliefs about the intrauterine device among teenagers and young women. Contraception, 82(2), 178–182. https://doi.org/10.1016/j.contraception.2010.02.020.CrossRefPubMedPubMedCentralGoogle Scholar
- Foster, D. G., Rostovtseva, D. P., Brindis, C. D., Biggs, M. A., Hulett, D., & Darney, P. D. (2009). Cost savings from the provision of specific methods of contraception in a publicly funded program. American Journal of Public Health, 99(3), 446–451. https://doi.org/10.2105/AJPH.2007.129353.CrossRefPubMedPubMedCentralGoogle Scholar
- Gomez, A. M., & Freihart, B. (2017). Motivations for interest, disinterest and uncertainty in intrauterine device use among young women. Maternal and Child Health Journal, 1–10. https://doi.org/10.1007/s10995-017-2297-9.
- Kaiser Family Foundation. (2014a). 2014 Employer Health Benefits Survey. Kaiser Family Foundation and Health Research & Educational Trust. Retrieved from http://kff.org/health-costs/report/2014-employer-health-benefits-survey/.
- Kaiser Family Foundation. (2014b). EHBS 2014—section thirteen: Grandfathered Health Plans—8625. Retrieved May 22, 2015, from http://kff.org/report-section/ehbs-2014-section-thirteen-grandfathered-health-plans/.
- Law, A., Wen, L., Lin, J., Tangirala, K., Schwartz, J. S., & Zampaglione, E. (2015). Are women benefiting from the Affordable Care Act? A real-world evaluation of the impact of the affordable care act on out-of-pocket costs for contraceptives. Contraception, 92(4), 374.Google Scholar
- Pauly, M. V. (1968). The economics of moral hazard: Comment. The American Economic Review, 58(3), 531–537.Google Scholar
- Strasser, J., Borkowski, L., Coulliard, M., Allina, A., & Wood, S. (2016). Long-acting reversible contraception: Overview of research and policy in the United States (Bridging the Divide: A Project of the Jacobs Institute of Women’s Health). Washington, D.C.: The George Washington University. Retrieved from https://publichealth.gwu.edu/sites/default/files/downloads/projects/JIWH/LARC_White_Paper_2016.pdf.
- Thompson, K. M. J., Rocca, C. H., Kohn, J. E., Goodman, S., Stern, L., Blum, M., … Harper, C. C. (2016). Public funding for contraception, provider training, and use of highly effective contraceptives: A cluster randomized trial. American Journal of Public Health, 106(3), 541–546. https://doi.org/10.2105/AJPH.2015.303001.CrossRefPubMedPubMedCentralGoogle Scholar
- Trussell, J. (2012). Update on and correction to the cost effectiveness of contraceptives in the United States. Contraception, 85(2), 218. https://doi.org/10.1016/j.contraception.2011.06.011.CrossRefPubMedGoogle Scholar