Ben Schwartz is Associate Editor, Contemporary OB/GYN.
A recent model challenges the rationale of limiting oral contraceptive dispensing as a means to control costs.
Despite mounting evidence that 12-month dispensing strategies for oral contraceptive pills (OCP) improve contraceptive access and reproductive outcomes, most insurance only allows for 3-month supplies as a means to control costs. To better understand the financial impact of a 12-month prescription, a recent study in JAMA Internal Medicine estimated the financial and reproductive health implications of implementing such a dispensing option in the Veterans Affairs (VA) health system.
The authors developed a decision model from the VA payer perspective to estimate incremental costs to the health care system if the option was available to receive a 12-month supply of OCPs up front, rather than the 3-month maximum currently in place. The model assumed a cohort of reproductive-aged, heterosexually active female VA enrollees who wish to avoid pregnancy for at least 1 year. Pregnancy outcomes included abortion, miscarriage, and live birth. Stillbirths and ectopic pregnancies were not included in the model since these outcomes represent fewer than 2% of pregnancies. Model outcomes were per-woman mean costs for 3-month and 12-month dispensing, incremental cost difference between strategies, and total incremental annual cost difference among all women using OCPs.
A couple of assumptions were also made for the model. Base case analyses assumed that 50% of OCP users opt to receive a 12-month supply of OCPs, and this value was varied from 0% to 100% in sensitivity analyses. Discontinuation rates were also treated as single variable in the model and equivalent between the 3- and 12-month strategies.
The model included a cohort of 24,309 women to calculate total annual costs. This number was based on the amount of VA enrollees who filled an OCP prescription during fiscal year 2017 (FY2017). Costs of OCP provision and pregnancy-related care were derived from VA administrative data. Veteran copayments represented negative intermediate costs to the VA and were fixed at $24 per 3-month supply or $96 per 12-month supply. Outcome costs included the mean costs incurred by the VA for live births (prenatal care, intrapartum and delivery care, and newborn care) and miscarriages. The VA does not cover pregnancy termination under any circumstance, so abortion cost was set at $0.
For the 12-month dispensing option, the mean annual cost per woman was $700.60 compared to $787.72 for the 3-month dispensing option (incremental VA cost savings = $87.12 per woman per year with the 12-month option). The cost savings from dispensing for the full 12 months primarily resulted from reductions in unintended pregnancies. Annually, 149 unintended pregnancies per 1000 women were expected with the 12-month option, while the 3-month option resulted in 173 expected unintended pregnancies per 1000 women. The absolute reduction of 24 unintended pregnancies translates to 583 unintended pregnancies averted annually.
The authors believe their findings are important for guiding policy on OCP dispensing. Because controlling cost is the main reason that insurance providers limit dispensing OCPs to 3 months, these results illustrate how implementing a 12-month OCP dispensing option actually provides greater cost savings for the VA while simultaneously providing better support for women’s reproductive goals.