EXECUTIVE SUMMARY

Findings from a new paper by researchers at the University of Pittsburgh and the U.S. Department of Veterans Affairs indicate that reducing birth control refills would better allow female veterans to prevent undesired pregnancies, with the money saved on healthcare costs more than outweighing the expense of providing multiple pill packs at one time.

• Researchers estimate that among the 24,000 women receiving birth control pills from the VA, offering a year’s supply of pills would prevent 583 unintended pregnancies and save the department about $2 million per year in prenatal, birth, and newborn care costs.

• The U.S. Selected Practice Recommendations for Contraceptive Use recommends providing up to a year’s supply of pills when a patient initiates pill use.


What is the common practice for providing multiple pill packs of oral contraceptives (OCs)? New research adds to the library of evidence that dispensing a year’s worth of pills reduces the rate of unintended pregnancies as well as costs.1

Findings from the new paper, published by researchers at the University of Pittsburgh and the U.S. Department of Veterans Affairs, indicate that reducing birth control refills would be more effective for preventing undesired pregnancies among female veterans. The money saved on healthcare costs would more than outweigh the expense of providing multiple pill packs at one time.

“Medication dispensing limits are thought to be cost-saving because you’re not wasting pills and medicines that people aren’t going to use,” lead author Colleen Judge-Golden, an MD/PhD student at Pitt’s School of Medicine, noted in a statement. “Our analysis shows that concerns about wastage of contraceptive pills are overshadowed by the potential consequences of missed refills, and especially of unintended pregnancies.” (The statement can be viewed online at: https://upmc.me/328MQ8b.)

Data supplied by the VA shows that 43% of women receiving three-month increments of birth control pills experience at least one gap between refills over the course of a year of use. Published data about civilian women who receive a year’s supply of pills up front shows that they experience fewer gaps and fewer unintended pregnancies.2-4

Facilitate Access to Contraception

The VA system, the largest integrated healthcare system in the United States, currently stipulates a three-month maximum dispensing limit for all medications, including oral contraceptives. Judge-Golden worked with senior author Sonya Borrero, MD, MS, director of Pitt’s Center for Women’s Health Research and Innovation and associate director of the VA Center for Health Equity Research and Promotion, and other investigators to develop a decision model for the department.

The researchers’ analysis estimated that among the 24,000 women receiving birth control pills from the VA, offering a year’s supply of pills would prevent 583 unintended pregnancies and save the department about $2 million per year in prenatal, birth, and newborn care costs.

“This is a great opportunity for the VA to roll out this policy change on a national level and continue to be a leader and set an elevated standard for women’s healthcare,” Borrero noted in the statement with Judge-Golden.

The CDC’s U.S. Selected Practice Recommendations for Contraceptive Use recommends providing up to a year’s supply of OCs when a patient initiates use.5 Research shows higher continuation rates when more pill packs are given up to 13 cycles. Limiting pill packs distributed or prescribed can result in unwanted OC discontinuation and increased risk for pregnancy, the guidance states.5 Eighteen states and the District of Columbia require that insurers cover the quantity of contraceptives dispensed in accordance with a prescription.

Power to Decide, a nonprofit campaign to prevent unplanned pregnancy, has worked with a panel of more than 50 experts to develop the Better Birth Control Framework, a collection of best practices that communities, states, and regions can use to make sure that policies, systems, programs, and financing are in place to ensure access to a full range of contraception. One of the platforms calls for public and private payers to cover a 12-month supply of self-administered hormonal contraception, such as pills, rings, or patches, at one time when prescribed and/or dispensed by a provider.

To expand access to contraception, a 2015 American College of Obstetricians and Gynecologists committee opinion calls for payment and practice policies that support provision of 3-13 month supplies of combined hormonal methods to improve contraceptive continuation.

REFERENCES

  1. Judge-Golden CP, Smith KJ, Mor MK, et al. Financial implications of 12-month dispensing of oral contraceptive pills in the Veterans Affairs Health Care System. JAMA Intern Med 2019;doi:10.1001/jamainternmed.2019.1678.
  2. White KO, Westhoff C. The effect of pack supply on oral contraceptive pill continuation: A randomized controlled trial. Obstet Gynecol 2011;118:615-22.
  3. Foster DG, Parvataneni R, de Bocanegra HT, et al. Number of oral contraceptive pill packages dispensed, method continuation, and costs. Obstet Gynecol 2006;108:1107-1114.
  4. Foster DG, Hulett D, Bradsberry M, et al. Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynecol 2011;117:566-572.
  5. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65:1-66.
  6. Committee on Health Care for Underserved Women. Committee opinion no. 615: Access to contraception. Obstet Gynecol 2015;125:250-255.