P083The impact of federal and state-level contraceptive coverage policies on contraceptive cost and use among privately insured women

Abstract

<h3>Objectives</h3> The landscape of contraceptive coverage has greatly changed in recent years due to federal- and state-level policymaking, yet the long-term effects on contraceptive use and costs remain largely unknown. <h3>Methods</h3> A retrospective analysis was performed using the IBM MarketScan® Commercial Claims and Encounters database to identify contraceptive claims and out-of-pocket costs among privately insured women aged 13–49 between 2006 and 2018. Long-acting reversible contraception (LARC) and non-LARC contraception claims were determined. Out-of-pocket costs included both contraceptive and insertion fees. Policies were categorized at the national level as pre-post Affordable Care Act (ACA), and at the state level as pre-post having a parity law requiring contraceptive coverage and pre-post having a law codifying the ACA at the state level. Descriptive statistics and visual plots assessed for trends between policies and outcomes. <h3>Results</h3> By 2018, seven states had both contraceptive parity laws and codification of the ACA contraceptive coverage; 22 states and the District of Columbia had only a parity law; and 21 states had neither policy. Claims data showed an upward trend in LARC insertion rates from 0.7% in 2006 to 4.6% in 2018, while non-LARC use remained relatively unchanged. The mean out-of-pocket expenditures for each contraceptive method declined each year after the ACA took effect, and there was an increase in the percentage of users who paid $0 for contraception. <h3>Conclusions</h3> This is the first study to investigate the impact of federal and state policies regarding contraceptive coverage. Findings show that contraceptive policies have an impact on use of the most effective contraceptive methods and on costs to the consumer.