The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance

Abstract

Background: Long-acting reversible contraception (LARC) is highly effective but also has higher initiation costs than oral contraceptive methods, which may contribute to relatively low use. The Affordable Care Act requires most private insurance plans to cover contraceptive services without patient cost-sharing. Whether this mandate will increase LARC use is unknown.

Objective: To assess the relationship between cost-sharing and use of LARC among privately insured women.

Design: Cross-sectional analysis using Truven Health MarketScan data from January 2011 to December 2011.

Subjects: Women aged 14-45 years with continuous insurance coverage enrolled in health plan products that covered branded and generic oral contraceptive pills (OCPs) and intrauterine devices (IUDs). We selected women using OCPs and IUDs as these are the most commonly used short-acting and long-acting reversible methods, respectively (N=1,682,425).

Measures: Multivariable regression was used to assess the association of the level of out-of-pocket costs for IUDs for each patient's plan and IUD initiation, adjusting for out-of-pocket costs for branded and generic OCPs and patient characteristics.

Results: Overall, 5.5% of women initiated an IUD in 2011. After adjustment, IUD initiation was less likely among women with higher versus lower co-pays (adjusted risk ratio=0.65; 95% CI, 0.64-0.67). Women who saw an obstetrician/gynecologist during 2011 were more likely to initiate an IUD (adjusted risk ratio=2.49; 95% CI, 2.45-2.53).

Conclusions: Rates of IUD use are low among privately insured women in the United States, and higher cost-sharing is associated with lower rates of IUD use. Together with other measures to promote LARC use, eliminating co-pays for contraception could promote the use of these more effective and cost-effective methods.

Figure 1:

Intrauterine Device Initiation by Cost-Sharing Level *“Low” out of pocket costs correspond to costs in the lowest quartile; “moderate” correspond to costs in the second and third quartiles, and “high” correlate to costs in the highest quartile. * Adjusted for age, region, employment status, recent visit to an ob/gyn, and levels of cost sharing for OCPs.