Coverage issues and IUD acceptance: a model for managed care.

Abstract

Adverse publicity about IUD-related complications and concerns about litigation have limited patients' requests for and physicians' recommendations of the IUD. For example, the Northern California Permanente Medical Group excluded the copper T380A IUD from its drug formulary until late 1995 because of litigation concerns. At the Kaiser Permanente Medical Center in San Francisco, California, use of the progesterone-releasing IUD (the only IUD available to Kaiser Foundation Health Plan members) has accounted for less than 1% of contraceptive use by members. Fees for insertion have included the acquisition cost of the device plus a small service charge and office visit registration; a sliding scale based on ability to pay has not been available. In 1996, however, IUDs will be covered under the Kaiser Foundation Health Plan's Supplemental Drug Plan, meaning the only charge will be small co-payment for the office visit. This decision was based on acceptance of the IUD within the medical community as a safe and effective contraceptive method, similarity of the IUD to other contraceptive devices covered by the Health Plan, increasing employer group requests for IUD coverage, and Kaiser Permanente physician support for the benefit coverage. If the IUD is to overcome its "image problem," greater efforts must be made to educate health care providers and women about the safety and effectiveness of this method.