Break down barriers to contraceptive access: Provide multiple pill packs
Break down barriers to contraceptive access: Provide multiple pill packs
Study: 13-month supply leads to more consistent use, less expense
Results of a new study indicate that providing women with an advance supply of oral contraceptives (OCs) results in fewer gaps in usage, longer-term contraceptive use, and less expense to health care providers and patients when compared with prescriptions that require multiple office visits or refills.1
The chief benefit of a 13-cycle dispensing practice is to facilitate more consistent pill use, explains Diana Greene Foster, PhD, a demographer at the University of California, San Francisco's Bixby Center for Reproductive Health Research & Policy. More consistent pill use is the goal for family planners, given that an estimated 11.6 million American women use oral contraceptive pills as their primary contraceptive method.2
Return visits to pharmacies or clinics to refill prescriptions may be the burden on women's time that results in discontinuation and gaps in OC use, reflects Foster, who served as lead author of the current study. Additional visits also may cause women to reconsider OC use — women with mild adverse effects characteristic of pill use may continue through the first few months of pill packs when they have a year's supply, but may stop using them if they must refill a prescription, she notes. Health care providers also may see benefits, says Foster: Researchers found lower direct costs for patients who received 13 cycles of pills because they had fewer visits and pregnancy tests.
"These findings provide rationale for health insurance programs to raise dispensing limits to one year," advocates Foster. "Women can ask about dispensing limits when choosing an insurance program, and should talk to their health care provider and ask for a greater quantity of pill packs."
Review the research
To perform the current study, researchers looked at more than 82,000 women who received birth control pills free of charge through the California Family Planning, Access, Care, and Treatment (PACT) Program. The program provides clinical services for family planning and reproductive health at no cost to more than one and a half million low-income California residents per year. Women in the study were given a complete one-, three-, or 13-month supply of pills at a single health care visit or with a one-time prescription to be filled at a pharmacy.
Data indicates that women who received 13 cycles were 28% more likely to continue using oral contraceptives after 15 months than women who obtained a three-month supply. They also experienced fewer gaps in pill coverage than women prescribed shorter cycles: 16% and 19% with one and three cycles had gaps in coverage, compared to 4% with 13 cycles.
Women who received a 13-month supply were more likely to have annual Pap and chlamydia tests than women who received fewer cycles, the analysis shows. Women who were given fewer cycles also were more likely to have at least one pregnancy test over the course of the year (45% and 46% with one and three cycles compared to 25% of women receiving 13 cycles), which suggests a greater perceived risk of pregnancy, perhaps due to gaps in coverage.
Over the year of study, Family PACT paid $99 more for women who received three cycles and $44 more for women who received only one cycle than for women who received 13 cycles at their first visit.
Cost may be a factor
Out-of-pocket costs for pills and the inconvenience of making monthly pharmacy visits may be barriers to some women's consistent use of the method. A 2004 analysis of nationally representative data indicates that privately insured women paid, on average, 60% of the total expenditures for birth control pills. Women paid an average of $14 per pack of pills, and 73% obtained only one pack per purchase, the analysis shows.3
Women who had no prescription drug coverage, were uninsured, or were privately insured but not in managed care plans had higher out-of-pocket expenditures for oral contraceptives, the analysis reveals.3 Women in managed care plans or without prescription drug coverage were more likely to obtain only one pack of pills per purchase.3 Insurer restrictions often limit purchases at community pharmacies to a 30-day supply. Better insurance coverage of contraceptives, increased access to generic or lower-cost pills, and expanded use of mail order prescription services that allow purchase of a 90-day supply of medication may aid in easing access for such women, the researchers conclude.3
What steps will it take to get policymakers and insurance companies to change restrictive practices? Evidence from well-designed trials that evaluate the impact of different models for making contraception more convenient, with a focus on such items as contraceptive initiation, continuance, rates of unintended pregnancy, or sexually transmitted infections and other unintended health outcomes, says Kirsten Moore, president of the Washington, DC-based Reproductive Health Technologies Project (RTHP). RTHP and the New York City-based Alan Guttmacher Institute hosted a 2003 meeting, "The Unfinished Revolution in Contraception: Convenience, Consumer Access and Choice," to examine such issues.
"For example, would pharmacy access for initiating hormonal contraception provide options for women who do not have a regular health care provider to access health care without increasing jeopardizing their health?" Moore asks. "Would giving women an annual supply of pills decrease the number of days a year she misses taking the pill?"
"Pills Now Pay Later"?
Planned Parenthood of New Mexico (PPNM) of Albuquerque has devised an innovative program to break down barriers to contraceptive access. Its "Pills Now Pay Later" (PNPL) program for distributing hormonal birth control, including the Pill and the contraceptive patch, was launched in March 2005.
Patients come into a PPNM medical office for a short visit, walk out the door with a 13-month supply of contraceptives, and pay only $20 per month over the course of the year, explains Linda Dominguez, NP, assistant medical director of the affiliate. The patient signs an agreement to have her credit card or bank account to be drafted each month. Currently, 1,300 patients are enrolled in the program, says Dominguez.
The program was created with consideration for women's busy lives. It is particularly advantageous for women living in rural areas, notes Dominguez. Among the 42 million uninsured in the United States, nearly 20% live in rural areas,4 says Dominguez. Not only do women in rural areas have to drive long distances to see a health care provider, they may not have convenient or confidential access to a pharmacy, she points out.
Although most insurance plans cover hormonal birth control, many require a co-pay of $10 to $30 and a monthly visit to the pharmacist to pick up the prescription, says Dominguez. Pills Now Pay Later makes it easier and less expensive for women in New Mexico to obtain and use contraception more effectively, she notes.
"As a clinician, it is apparent to me that patients are eager for an opportunity to have a quick and convenient way to access supplies and thereby be successful in their contraceptive and reproductive plan," states Dominguez. "PPNM has developed this critical program to meet women's needs."
References
- Foster DG, Parvataneni R, de Bocanegra HT, et al. Number of oral contraceptive pill packages dispensed, method continuation, and costs. Obstet Gynecol 2006; 108:1,107-1,114.
- Mosher WD, Martinez GM, Chandra A, et al. Use of contraception and use of family planning services in the United States: 1982-2002. Adv Data 2004; 350:1-36.
- Phillips KA, Stotland NE, Liang SY, et al. Out-of-pocket expenditures for oral contraceptives and number of packs per purchase. J Am Med Womens Assoc 2004; 59:36-42.
- Kaiser Commission on Medicaid and the Uninsured. The Uninsured in Rural America. Washington, DC; 2001.
Resource
For more information on the Pills Now Pay Later (PNPL) proprietary business process, contact:
- Jenny Black, Planned Parenthood of New Mexico, 719 San Mateo NE, Albuquerque, NM 87108. E-mail: [email protected]. The PNPL program can be made available to other Planned Parenthood affiliates. Pill prices are tailored to the participating affiliate.
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