Law requiring 12-month contraceptive scripts falls flat

Researchers have found that an Oregon law allowing women to receive 12-month supplies of short-acting contraceptives has not resulted in an increase in these extended prescriptions.

dr Maria Rodriguez

The 2016 regulation was intended to help women avoid disruptions in reproductive care coverage, reduce the hassle of filling prescriptions, and reduce the risk of unwanted pregnancy. But the new research shows the policy had little impact, at least in Oregon, according to Maria Rodriguez, MD, MPH, associate professor of obstetrics and gynecology at Oregon Health & Science University, Portland.

After the transition, more than 80% of Oregon women were on short-acting contraceptives—pills, rings, or hormone patches—of 3 months or less. Only 3.7% received supplies for 12 months, essentially the same number as the 3.5% before the bill passed.

“It was an expected disappointment,” said Rodriguez, associate editor of the Cochrane Fertility Regulation Group at OHSU, whose group reported the findings in todayJAMA health forum.

Rodriguez said she’s pleased to see a significant increase in the number of women receiving 1 month supplies to 2-3 month supplies. A third of the women received full 12-month supplies.

“This is an important improvement. This increase means only four pharmacy visits per year, compared to 12,” said Rodriguez Medscape Medical News.

The study sample included 639,053 prescriptions among Oregon women, most of whom were privately insured (78.6%) and lived in metropolitan areas (78.6%). Oral contraception was the most commonly prescribed form of contraception (90.8%) in the study population.

Women who received Medicaid were nine times more likely to receive 12-month supplies than women with private insurance.

dr Jonah Fleischer

Jonah Fleisher, MD, MPH, a gynecologist and specialist in complex family planning at the University of Illinois College of Medicine at Chicago, said Medicaid may be faster than private airlines in adapting its policies to new regulatory requirements. Additionally, in Oregon, 43% of the privately insured population is covered by self-insured plans, which are exempt from this state law requiring 12-month coverage, he noted.

Oregon’s system also requires a patient to see their doctor a second time for the greater amount of contraception, which has been shown to improve effectiveness and prevent unplanned pregnancies. “A real requirement to spend a 12-month supply on new prescriptions can help ensure more people actually get the intended amount,” Fleisher said.

Rodriguez said the study is the first to look at the implementation of similar measures to expand contraceptive supply. A total of 20 states and the District of Columbia have adopted policies to encourage expanded contraceptive coverage, according to the Guttmacher Institute, a nonprofit organization dedicated to sexual and reproductive health and rights.

“Passing legislation is just the first step of many to improve health services and outcomes. This seems like an obvious point, but in practice I feel like this is often overlooked,” she told Medscape. “One of my motivations in leading this study was a call to action – if we fail to fully implement evidence-based health policy, we will not improve public health.”

A key obstacle to the success of the 2016 law, Rodriguez added, is that the policy is not accompanied by means to promote awareness of the provision.

“If women don’t know the law, they won’t know it’s their right to have increased care, prescribing doctors won’t be aware they can prescribe it, and pharmacists might feel uncomfortable about it.” fill,” she said. “In order for this policy to be fully implemented, insurance companies must also be contacted to inform them of the change in law and hold them accountable for compliance.”

Sonya Borrero, MD, director of the Center for Innovative Research on Gender Health Equity at the University of Pittsburgh Medical Center, Pittsburgh, Pa., said she believes a federal mandate is needed to ensure equal access to short-acting contraceptives regardless of region or to guarantee the insurer.

Rodriquez agreed that a unified policy would be better than the current patchwork system. “Requiring a woman to go to the pharmacy every month to get a new pack of pills is bad medicine,” she said.

“We need papers that publish successes, and in this case an unrealized success,” Fleisher said. “The laws are there, but the practices are not.”

Rodriguez reported receiving grants from the National Institute of Minority Health & Health Disparities while conducting the study and personal fees from the American College of Obstetricians and Gynecologists, Bayer, and Merck & Co. outside of the submitted work.

JAMA health forum. Published online February 18, 2022. Full text

Howard Wolinsky is a medical editor based in Chicago.

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