Prescription Contraceptive Sales Following the Affordable Care Act

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1

Source Symphony Health Solutions’ Pharmaceutical Audit Suite (PHAST), January 2008–June 2014

Fig. 2

Source Symphony Health Solutions’ Pharmaceutical Audit Suite (PHAST), January 2008–June 2014. Note that these two graphs are scaled differently to clearly show differences in trends

References

  1. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Atkins, D. N., & Bradford, W. D. (2014). Changes in state prescription contraceptive mandates for insurers: The effect on women’s contraceptive use. Perspectives on Sexual and Reproductive Health, 46(1), 23–29.

    Article  Google Scholar 

  3. Bearak, J. M., Finer, L. B., Jerman, J., & Kavanaugh, M. L. (2016). Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable Care Act: An analysis of insurance benefit inquiries. Contraception, 93(2), 139–144.

    Article  Google Scholar 

  4. Becker, N. V., & Polsky, D. (2015). Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing. Health Affairs, 34(7), 1204–1211. https://doi.org/10.1377/hlthaff.2015.0127.

    Article  PubMed  Google Scholar 

  5. Bergin, A., Tristan, S., Terplan, M., Gilliam, M. L., & Whitaker, A. K. (2012). A missed opportunity for care: Two-visit IUD insertion protocols inhibit placement. Contraception, 86(6), 694–697.

    Article  Google Scholar 

  6. 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.

  7. Browne, S. P., & LaLumia, S. (2014). The effects of contraception on female poverty. Journal of Policy Analysis and Management, 33(3), 602–622.

    Article  Google Scholar 

  8. Carlin, C. S., Fertig, A. R., & Dowd, B. E. (2016). Affordable Care Act’s mandate eliminating contraceptive cost sharing influenced choices of women with employer coverage. Health Affairs, 35(9), 1608–1615.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cintina, I., & Johansen, M. S. (2015). The effect of plan B on teen abortions: Evidence from the 2006 FDA ruling. Contemporary Economic Policy, 33(3), 418–433. https://doi.org/10.1111/coep.12083.

    Article  Google Scholar 

  11. Claxton, G., Rae, M., Panchal, N., Whitmore, H., Damico, A., & Kenward, K. (2014). Health benefits in 2014: Stability in premiums and coverage for employer-sponsored plans. Health Affairs, 33(10), 1851–1860. https://doi.org/10.1377/hlthaff.2014.0792.

    Article  PubMed  Google Scholar 

  12. Currie, J., & Schwandt, H. (2014). Short- and long-term effects of unemployment on fertility. Proceedings of the National Academy of Sciences, 111(41), 14734–14739. https://doi.org/10.1073/pnas.1408975111.

    CAS  Article  Google Scholar 

  13. 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.

  14. Dills, A. K., & Grecu, A. M. (2017). Effects of state contraceptive insurance mandates. Economics & Human Biology, 24, 30–42. https://doi.org/10.1016/j.ehb.2016.11.004.

    Article  Google Scholar 

  15. Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA, 312(22), 2401–2402.

    CAS  Article  Google Scholar 

  16. Dusetzina, S. B., Dalton, V. K., Chernew, M. E., Pace, L. E., Bowden, G., & Fendrick, A. M. (2013). Cost of contraceptive methods to privately insured women in the United States. Women’s Health Issues, 23(2), e69–e71. https://doi.org/10.1016/j.whi.2013.01.002.

    Article  PubMed  Google Scholar 

  17. Fiebig, D. G., Viney, R., Knox, S., Haas, M., Street, D. J., Hole, A. R., … Bateson, D. (2015). Consideration sets and their role in modelling doctor recommendations about contraceptives. Health Economics. https://doi.org/10.1002/hec.3276.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goldin, C., & Katz, L. F. (2002). The power of the pill: Oral contraceptives and women’s career and marriage decisions. Journal of Political Economy, 110(4), 730–770. https://doi.org/10.1086/340778.

    Article  Google Scholar 

  21. 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.

  22. Hladky, K. J., Allsworth, J. E., Madden, T., Secura, G. M., & Peipert, J. F. (2011). Womenʼs knowledge about intrauterine contraception. Obstetrics & Gynecology, 117(1), 48–54. https://doi.org/10.1097/AOG.0b013e318202b4c9.

    Article  Google Scholar 

  23. Johnston, E. M., & Adams, E. K. (2017). State prescription contraception insurance mandates: Effects on unintended births. Health Services Research, 52(6), 1970–1995. https://doi.org/10.1111/1475-6773.12792.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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/.

  25. 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/.

  26. Kearney, M. S., & Levine, P. B. (2009). Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics, 91(1), 137–151.

    Article  Google Scholar 

  27. 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 

  28. Magnusson, B. M., Sabik, L., Chapman, D. A., Masho, S. W., Lafata, J. E., Bradley, C. J., & Lapane, K. L. (2012). Contraceptive insurance mandates and consistent contraceptive use among privately insured women. Medical Care, 50(7), 562–568.

    Article  Google Scholar 

  29. Mulligan, K. (2015). Contraception use, abortions, and births: The effect of insurance mandates. Demography, 52(4), 1195–1217. https://doi.org/10.1007/s13524-015-0412-3.

    Article  PubMed  Google Scholar 

  30. Pace, L. E., Dusetzina, S. B., & Keating, N. L. (2016a). Early impact of the Affordable Care Act on oral contraceptive cost sharing, discontinuation, and nonadherence. Health Affairs, 35(9), 1616–1624. https://doi.org/10.1377/hlthaff.2015.1624.

    Article  PubMed  Google Scholar 

  31. Pace, L. E., Dusetzina, S. B., & Keating, N. L. (2016b). Early impact of the Affordable Care Act on uptake of long-acting reversible contraceptive methods. Medical Care, 54(9), 811–817.

    Article  Google Scholar 

  32. Pauly, M. V. (1968). The economics of moral hazard: Comment. The American Economic Review, 58(3), 531–537.

    Google Scholar 

  33. Raissian, K. M., & Lopoo, L. M. (2015). Mandating prescription contraception coverage: Effects on contraception consumption and preventive health services. Population Research and Policy Review, 34(4), 481–510.

    Article  Google Scholar 

  34. Sonfield, A., Gold, R. B., Frost, J. J., & Darroch, J. E. (2004). US insurance coverage of contraceptives and the impact of contraceptive coverage mandates, 2002. Perspectives on Sexual and Reproductive Health, 36(2), 72–79.

    Article  Google Scholar 

  35. 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.

  36. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. Trussell, J., Lalla, A. M., Doan, Q. V., Reyes, E., Pinto, L., & Gricar, J. (2009). Cost effectiveness of contraceptives in the United States. Contraception, 79(1), 5–14.

    Article  Google Scholar 

  39. Tyler, C. P., Whiteman, M. K., Zapata, L. B., Curtis, K. M., Hillis, S. D., & Marchbanks, P. A. (2012). Health care provider attitudes and practices related to intrauterine devices for nulliparous women. Obstetrics & Gynecology, 119(4), 762–771.

    Article  Google Scholar 

  40. Weisman, C. S., & Chuang, C. H. (2014). Making the most of the Affordable Care Act’s contraceptive coverage mandate for privately-insured women. Women’s Health Issues, 24(5), 465–468. https://doi.org/10.1016/j.whi.2014.07.004.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Lindsey Rose Bullinger.

Ethics declarations

Conflict of interest

No conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 92 KB)

Supplementary material 2 (DOCX 13 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bullinger, L.R., Simon, K. Prescription Contraceptive Sales Following the Affordable Care Act. Matern Child Health J 23, 657–666 (2019). https://doi.org/10.1007/s10995-018-2680-1

Download citation

Keywords

  • Prescription contraceptives
  • Affordable Care Act
  • LARC methods