THE IMPACT OF THE AFFORDABLE CARE ACT ON CONTRACEPTIVE USE AND COSTS AMONG PRIVATELY INSURED WOMEN

Open Access
Author:
Snyder, Ashley H
Graduate Program:
Public Health Sciences
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
March 20, 2017
Committee Members:
  • Cynthia H. Chuang, MD, MSc, Thesis Advisor
Keywords:
  • Affordable Care Act (ACA)
  • out-of-pocket cost
  • cost-sharing
  • intrauterine device (IUD)
  • contraception
  • long-acting reversible contraceptive (LARC)
Abstract:
Objectives: The contraceptive coverage mandate in the Affordable Care Act (ACA) requires private health insurance plans to cover all Food and Drug Administration-approved contraceptive methods without cost-sharing. We evaluate the impact of this policy on cost and use of long-acting reversible contraceptives (LARCs) and other prescription methods through 2014. Study Design: Data from Truven Health MarketScanĀ® were used to examine out-of-pocket costs and contraceptive use patterns for all reversible prescription contraceptives before and after implementation of the contraceptive mandate in August 2012. Study cohorts for calendar years 2005 to 2014 included women ages 13-45 with continuous medical and pharmacy coverage within each year. Costs were estimated by combining copayment, coinsurance and deductible payments for both contraception and insertion fees for LARCs. Multivariable logistic regression comparing LARC insertions pre- and post-ACA was performed adjusting for year, age group, geographic region, and urban versus rural residence. Results: Rates of new LARC insertions increased over each study year. Rates of claims for LARC insertions decreased slightly post-ACA when controlling for cohort year, age group, geographic region, and rural versus urban setting. Out-of-pocket costs for LARCs decreased sharply post-ACA contraceptive mandate. Conclusions: While out-of-pocket costs for prescription contraceptives decreased post-ACA, there was not an increased uptake of LARCs beyond what would be expected based on the secular trend. The full impact of the contraceptive mandate on contraceptive use patterns may not be clear until more years of data are available.