Effects of the Affordable Care Act's contraceptive coverage requirement on the utilization and out-of-pocket costs of prescribed oral contraceptives

Abstract

Background: The Affordable Care Act (ACA) mandated that private health insurance plans cover prescribed contraceptive services for women, including oral contraceptives (OCs), without charging a patient any cost-sharing beginning in August 2012.

Objective: To evaluate the effects of the ACA's contraceptive coverage requirement on the utilization and out-of-pocket costs of prescribed OCs after two years of implementation.

Methods: A retrospective, cross-sectional study was designed using data from the 2010 to 2014 waves of the Medical Expenditure Panel Survey. The sample consisted of reproductive-aged women who have either private health insurance or Medicaid. Utilization of OCs was evaluated using 1) the proportion of women who purchased any OCs and 2) the mean annual number of cycles prescribed per woman. Out-of-pocket costs for OCs were evaluated using 1) the proportion of women who had any OC purchase with $0 out-of-pocket costs, 2) the mean annual out-of-pocket costs per woman, and 3) the mean out-of-pocket costs per cycle. Descriptive analyses and a difference-in-difference linear regression approach were used.

Main findings: No substantial changes were seen in the utilization of OCs after the ACA requirement became effective. The difference-in-difference regression showed that the proportion of women who had any OC purchase with $0 out-of-pocket costs increased significantly by 54.0 percentage points after the ACA requirement in the private insurance group relative to the Medicaid group. Mean annual out-of-pocket costs in the private insurance group dropped by 37% in the first year and an additional 52% decrease was found in the second year of the policy. Mean out-of-pocket costs per cycle also decreased substantially in the private insurance group by 39% in the first year and an additional decrease of 44% was seen in the second year.

Conclusions: The ACA's contraceptive coverage requirement markedly reduced out-of-pocket costs of prescribed OCs for women with private health insurance.

Keywords: Affordable Care Act; Contraceptive coverage requirement; Health policy; Oral contraceptives; Out-of-pocket costs.