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.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
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.
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.
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.
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.
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.
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.
Browne, S. P., & LaLumia, S. (2014). The effects of contraception on female poverty. Journal of Policy Analysis and Management, 33(3), 602–622.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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/.
Kearney, M. S., & Levine, P. B. (2009). Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics, 91(1), 137–151.
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.
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.
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.
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.
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.
Pauly, M. V. (1968). The economics of moral hazard: Comment. The American Economic Review, 58(3), 531–537.
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.
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.
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.
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.
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.
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.
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.
Conflict of interest
No conflicts of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
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
- Prescription contraceptives
- Affordable Care Act
- LARC methods