Contraceptive utilization at publicly funded clinics before and after introduction of low-cost levonorgestrel intrauterine system: a retrospective case study analysis

Abstract

ABSTRACT Cost can be a barrier to accessing safe and affordable contraception. Therefore, we sought to understand how the availability and utilization of a low-cost levonorgestrel intrauterine system (hormonal IUD) impacts uptake relative to other contraceptive methods. Another objective was to determine if the percentage of self-pay women who obtained a hormonal IUD changed over time. Electronic health record (EHR) data was collected from five public health organizations enrolled in the 340B drug-pricing program (30 individual health centers) from April 15, 2014, through December 31, 2017, with most sites receiving Title X funding. The study captured data before and after low-cost hormonal IUD introduction. Interview data from 28 key informants provided a deeper understanding of how trends in hormonal IUD use changed after low-cost hormonal IUD introduction. Encounters from 101,075 women were analyzed. Locally weighted scatterplot smoothing (LOWESS) trends revealed an increasing utilization for all long-acting reversible contraception (LARC) and a decreasing trend for short-acting methods. Among self-pay women, hormonal IUD uptake increased 3 percentage points (p < .001) after the introduction of low-cost hormonal IUD. Privately insured women saw a 7-percentage point increase in hormonal IUD uptake while women whose family income was greater than 200% of the federal poverty level (FPL) saw a 13.9 percentage point increase in hormonal IUD uptake. The introduction of a low-cost hormonal IUD was associated with more self-pay and low-income women accessing this method. Access to and utilization of low-cost hormonal IUDs are complicated by many factors including product availability and provider training.