How are oral contraceptives being used in today’s family planning practices? The Affordable Care Act (ACA) might be making a difference when it comes to use of the Pill. Between 2012 and 2013, the number of women who filled prescriptions for the Pill with no co-pay more than quadrupled from 1.2 million to 5.1 million, according to data from the IMS Institute for Healthcare Informatics in Parsippany, NJ, an information and technology service.1
According to IMS research, the total number of prescriptions for oral contraceptives with no co-pay jumped from 6.8 million in 2012 to 31.1 million in 2013 in part due to the Affordable Care Act’s zero-cost sharing provisions for certain preventive services.1
The increase in oral contraceptive prescriptions dispensed with no co-pay contributed to a $483.3 million reduction in out-of-pocket costs that would have been spent in 2013 had women bought the same mix of oral contraceptives as those purchased in 2012, according to IMS estimates.1
Karen Albright, WHNP-BC, lead clinician at Virginia League for Planned Parenthood in Virginia Beach, is seeing more patients use the discounted pills available at larger pharmacies such as Wal-Mart and Target. For young women with no insurance or high deductibles, access to such discounted pills has been very helpful, says Albright. (For a list of Wal-Mart $9 per month generic OCs, go to http://bit.ly/1stGe0z. For Target, which offers two generic OCs for $9 per month, go to http://bit.ly/1z2GIuD.)
To help patients compare costs of branded pills versus generics, Albright has patients input www.goodrx.com into their cellphones while talking with them in the exam room. This web site allows patients to compare costs at various local pharmacies, she notes.
How are pills being used in today’s practices? Results of the 2014 Contraceptive Technology Update Contraception Survey give insight on how providers are providing OCs.
Almost 97% of survey participants say their facilities use the Quick Start method of initiating same-day use of combined hormonal contraceptives. This statistic is a marked jump from 2013’s 75% number, and a significant climb from the 64.5% response in 2007 when the question first was asked.
With the official encouragement to do Quick Start/Same Day Start for every woman using combined pills from the Centers for Disease Control and Prevention’s U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (SPR),2 Quick Start should be the new standard, says Anita Nelson, MD, professor in the Obstetrics and Gynecology Department at the David Geffen School of Medicine at the University of California in Los Angeles. Unfortunately, there are no outcome measures relating to family planning in the ACA regulations, she states.
If your facility allows direct dispensing, how many packages of pills do you provide to women who already have been on pills and are experiencing no problems at all? About 36% of survey participants say their program allows them to provide 12 or 13 packs at an annual visit, with an equal amount indicating they can issue three to five packs. Around 14% say they give out six to 11 packs. More packs dispensed might equal heightened compliance. A small body of evidence suggests that dispensing a greater number of oral contraceptive pill packs might increase continuation of use.3
About half of 2014 CTU survey participants say 1% to 10% of patients using combined pills leave offices with prescriptions for extended or continuous regimens. About 27% of respondents say 25% or more of patients use pills in such manner.
Prescribing pills in this manner might aid in decreasing rates of unintended pregnancy. In a 2014 retrospective claims analysis, real-world pregnancy rates were lower with 84/7 regimens versus 21/7 and 24/4 regimens.4
After what period of time postpartum do 2014 survey participants say they usually recommend that a woman who is not breastfeeding start taking combined oral contraceptives? About 72% say they opt for four to six weeks postpartum.
According to the U.S. Medical Eligibility Criteria for Contraceptive Use” (US MEC), no restriction (Category 1) applies for the use of combined hormonal contraceptives in women who are more than 42 days postpartum and are not breastfeeding. During 21-42 days postpartum, women without risk factors for venous thromboembolism generally can initiate combined hormonal contraceptives, but women with risk factors generally should not use these methods, the guidance notes. Combined hormonal contraception is classified as a Category 4 (unacceptable health risk) for all postpartum women, regardless of breastfeeding status, for the first 21 days postpartum.5
After what period of time postpartum do 2014 survey participants usually recommend that a woman who is breastfeeding start taking progestin-only oral contraceptives? About 40% say they provide such pills one to three weeks postpartum, while 31% report provision four to six weeks postpartum. Twenty-eight percent provide pills on hospital discharge.
Progestin-only hormonal methods, including progestin-only pills, depot medroxyprogesterone acetate injections, and implants, are safe for postpartum women, including women who are breastfeeding, and they can be initiated immediately postpartum (Categories 1 and 2), according to the US MEC.5
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Burke A, Simmons A. Increased coverage of preventive services with zero cost sharing under the Affordable Care Act. ASPE Issue Brief 2014; accessed at http://1.usa.gov/1G9RqD.
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Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep 2013; 62(RR-05):1-60.
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Steenland MW, Rodriguez MI, Marchbanks PA, et al. How does the number of oral contraceptive pill packs dispensed or prescribed affect continuation and other measures of consistent and correct use? A systematic review. Contraception 2013; 87(5):605-610.
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Howard B, Trussell J, Grubb E, et al. Comparison of pregnancy rates in users of extended and cyclic combined oral contraceptive (COC) regimens in the United States: a brief report. Contraception 2014; 89(1):25-27.
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Centers for Disease Control and Prevention (CDC). Update to CDC’s U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. MMWR 2011; 60(26):878-883.
