New research finds benefits in dispensing a year’s worth of birth control pills up-front
Distributing a year’s supply of birth-control pills to women up-front reduces unintended pregnancies, according to new research from the University of Pittsburgh and the U.S. Department of Veterans Affairs.
In addition to supporting reproductive autonomy, the study shows the policy is economically feasible. Lead author Dr. Colleen Judge-Golden said her team weighed the costs of giving patients more oral contraceptive pills at a time against pregnancy healthcare costs. There’s a clear winner, she said: providing more birth-control pills.
“We found that the concern over potential wastage is overshadowed by the health-care costs that are associated with pregnancy,” Judge-Golden said.
Right now, there’s no national standard for dispensing periods of oral contraceptives. Seventy percent of women receive
a supply of three months or less, and 15 percent receive a supply of more than six months, according to the Henry J. Kaiser Foundation.
Seventeen states and the District of Columbia have passed laws requiring insurers to cover 12 months of birth-control pills. But the reality is that even in those states, it’s difficult for people to get a year’s coverage up-front, according to Sally Rafie, a pharmacist specialist and founder of Birth Control Pharmacist.
“The way the laws are written is that it requires the insurance companies to pay for a full year’s supply at once if the patient requests it,” Rafie said. “The insurance companies often are not covering a full-year supply. The accountability and monitoring of compliance with mandates like that is the problem.”
Some insurance companies are reluctant to offer 12 months of contraceptives at a time, says Cathryn Donaldson, communications director for American Health Insurance Plans. One reason for concern, Donaldson said, is that using any medication in the long term comes with risks.
“Side effects and improper use of prescription drugs can have a serious and potentially life-threatening impact on a patient, which is why it is recommended patients regularly consult their physician, pharmacist or other care provider,” Donaldson wrote to USA Today.
Donaldson also said 12-month supplies could prompt “waste, fraud, abuse and increased costs.” Instead, patients can have refills of oral contraceptives delivered to them before their supply is out, she said.
“It’s important to remember that before the 90 day supply is exhausted, a refill can seamlessly be delivered to the home of the individual, encouraging adherence while easing the need to travel to a pharmacy or other location,” Donaldson said.
Sonya Borrero, an author of the new study and a physician with the VA Pittsburgh HealthCare Center, said implementing a universal 12-month birth-control pill policy would take further efforts. She’s hopeful, though, that implementing it within the VA will inspire similar policies.
“The VA is the largest integrated healthcare system in the US,” Borrero said. “Pushing forward with policy like this really could get some national recognition and impact.”
Typically, prescriptions are written for a full year, but most insurance plans, including the VA, have a 90-day dispensing limit. Ninety days is the norm for all medications, mainly to prevent medication waste, as Donaldson mentioned. But oral contraceptives are different in that missing a couple of days dramatically increases the risk for unintended pregnancies, Borrero said.
These findings are supported by earlier research as well. Diana Greene Foster, a professor in reproductive sciences at the University of California-San Francisco, led research efforts in 2006 and 2011 highlighting the benefits of providing 12 months of birth-control pills in one visit. Her first paper found that this practice resulted in lower costs, and her second demonstrated fewer unintended pregnancies and abortions.
“On the basis of those studies, many states actually changed their law to allow for a year supply,” Foster said. “It’s so gratifying to have scientific evidence change policy.”
Gretchen Ely, an associate dean specializing in access to contraception at the University at Buffalo, said a major advantage of a year’s supply of birth control up-front is that it interferes minimally with people’s lives.
“The concern is the more often people have to check in to get new medication, the more often there’s a chance for their lives to be too chaotic, or something’s going on and they get off their pill,” Ely said. “That is the purpose of the advocacy, being that is to try and increase accessibility, especially for more vulnerable populations who might have more trouble.”
Foster said there are many reasons a woman might skip picking up her birth control. She recalled a one case: While serving as an expert witness in a hearing at the Alaska State Legislature, she heard an Alaska woman detail difficulties accessing birth control while captaining a fishing ship in the summer.
“A captain of a fishery fleet called in because it hurt her business, hurt her logistics, to have to come in for prescriptions,” she said.