Insurance status and coverage can create barriers to accessing prescription contraceptives.
12-month supplies of contraceptives result in better adherence and lower rates of unintended pregnancy.
In states that allow for a 12-month supply of contraceptives to be dispensed, healthcare providers are not doing so due to a lack of knowledge of state policy.
Short- and long-acting reversible contraceptives that require a prescription or medical procedure are more effective than over-the-counter contraceptives (e.g., condoms, spermicides; Britton et al. 2020).
Individuals who have tried to obtain a hormonal contraception prescription reported difficulty accessing (Grindlay et al. 2016):
Missouri. Ten of 14 urban counties and 98 of 101 rural counties have at least one area that lacks access to primary medical care as determined by patient-to-physician ratio, income, infant health, and proximity to a healthcare facility (MO DHSS 2015, 2021; HRSA 2022).
In a survey of Missouri women who had an unintended pregnancy while not using a contraceptive, 7% reported problems acquiring birth control (PRAMS 2015). The rest reported not using contraception for other reasons, including:
Access. Before pregnancy, 60% of Missouri women have employer-provided insurance, 17% have Medicaid, and 19% do not have health insurance (PRAMS 2020).
In a large national study of sexually active women not seeking pregnancy, 81% of uninsured women and 85%-90% of insured women had used some form of contraception within a month of the survey (Kavanaugh et al. 2020).
Contraception that requires a prescription or medical procedure is higher among insured wo-men (16%-32%) compared to uninsured women (16%-18%). Access varies based on insurance coverage and the type of contraceptive used (Kavanaugh et al. 2020).
White Missourians are more likely to have health insurance (90%), compared to Black (86%) and Hispanic (78%) Missourians. Similarly, Black and Hispanic women are more likely to report no doctor visits over the last year (16% and 24%, respectively), due to cost, compared to White women (10%; KFF 2021).
Coverage. Most insurance plans cover 1–3 months of prescription contraceptives at a time. Insured and uninsured women report barriers to obtaining prescriptions and refills (Nikpour et al. 2020). Difficulty getting refills can result in gaps in use or stopping use altogether (ACOG 2015).
1-year vs. 3-month supply of contraceptives can:
Between 1970 and 1990, increased access to the birth control pill increased women’s workforce participation, as well as wages and salaries over a woman’s lifetime (Bernstein & Jones 2019).
Twenty states and Washington, D.C. require insurance coverage for an extended supply (1 year) of contraceptives. 17 of these states pro-hibit cost sharing of contraceptives (Figure 1).
National and state (OR, MA) data suggests that healthcare professionals do not prescribe more 1-year prescriptions, even if their state had ex-panded coverage. This is primarily due to a lack of awareness of the policy and confusion over insurance coverage (Fuerst et al. 2022; Qasba et al. 2022; Qasba et al. 2022; Rodriguez et al. 2022).
Changing the standardized prescription order default from one month to 12 months resulted in significantly more 1-year contraceptive prescriptions in CA between 2019 and 2020 (Uhm et al. 2021).
Figure 1. States with expanded contraceptive coverage policies (Guttmacher, 2023).
American College of Obstetricians and Gynecologists. (2015). Committee Opinion: Contraceptive Accessibility. Retrieved February 2022 from https://www.acog.org/clinical/clinical-guidance/committeeopinion/articles/2015/01/access-to-contraception
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Bernstein, A., & Jones, K. (2019, September 26). The Economic Effects of Contraceptive Access: A Review of the Evidence. Retrieved from Institute for Women's Policy Research: https://iwpr.org/iwpr-issues/reproductive-health/the-economic-effects-of-contraceptive-access-a-review-of-the-evidence/
Foster, D. G., Parvataneni, R., de Bocanegra, H. T., Lewis, C., Bradsberry, M., & Darney, P. (2006). Number of oral contraceptive pill packages dispensed, method continuation, and costs. Obstetrics & Gynecology, 108(5), 1107-1114.
Foster, D. G., Hulett, D., Bradsberry, M., Darney, P., & Policar, M. (2011). Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstetrics & Gynecology, 117(3), 566-572.
Fuerst MF, Schrote K, Garg B, Rodriguez MI. Association of 12-month contraceptive supply policy and months of oral contraception prescribed by obstetrics and gynecology resident physicians: an exploratory cross-sectional study. BMC Womens Health. 2022 Jul 10;22(1):287. doi: 10.1186/s12905-022-01869-w. PMID: 35820853; PMCID: PMC9275067.
Grindlay, K., & Grossman, D. (2016). Prescription birth control access among US women at risk of unintended pregnancy. Journal of Women's Health, 25(3), 249-254.
Health Resources & Services Administration. (2022). HPSA find. Retrieved from data.HRSA.gov: https://data.hrsa.gov/tools/shortage-area/hpsa-find
Judge-Golden, C.P., Smith, K.J., Mor, M.K. and Borrero, S., (2019). Financial implications of 12-month dispensing of oral contraceptive pills in the Veterans Affairs health care system. JAMA Internal Medicine, 179(9), pp.1201-1208.
Kaiser Family Foundation. (2019). Oral Contraceptive Pills. Retrieved February 2022 from https://www.kff.org/womens-health-policy/fact-sheet/oral-contraceptive-pills
Kaiser Family Foundation. (2021). Uninsured Rates for the Nonelderty by Race/Ethnicity. Retrieved from KFF State Health Facts: https://www.kff.org/uninsured/state-indicator/nonelderly-uninsured-rate-by-raceethnicity/
Kaiser Family Foundation. (2021). Women Who Report Not Seeing a Doctor in the Past 12 Months Due to Cost by Race/Ethnicity. Retrieved from KFF State Health Facts: https://www.kff.org/womens-health-policy/state-indicator/women-who-did-not-see-a-doctor-in-the-past-12-months-due-to-cost-by-race-ethnicity/
Kavanaugh, M. L., & Pliskin, E. (2020). Use of contraception among reproductive-aged women in the United Staes, 2014 and 2016. F&S Reports, 83-93.
Missouri Department of Health and Senior Services. (2015). Women's Health. Retrieved from Office of Primary Care & Rural Health: https://health.mo.gov/living/families/ruralhealth/pdf/rural-womens-health.pdf
Missouri Department of Health and Senior Services. (2018, March). Missouri Pregnancy Risk Assessment Monitoring System Surveillance Report. Retrieved from Data, Surveillance Systems & Statistical Reports: https://health.mo.gov/data/prams/pdf/prams_report2015.pdf
Missouri Department of Health and Senior Services. (2021). Health in Rural Missouri Biennial Report 2020-2021. Retrieved from Rural Health Publications: https://health.mo.gov/living/families/ruralhealth/publications.php
Missouri Department of Health and Senior Services. (2021). Missouri Pregnancy Risk Assessment Monitoring System. Retrieved from Missouri Department of Health and Senior Services: https://health.mo.gov/data/prams/prams-dashboard.php
New Jersey Department of Health. (2022, January 13). Governor Murphy Signs Historic Legislation to Expand and Protect Reproductive Freedom in New Jersey. Retrieved from News: https://www.nj.gov/health/news/2022/approved/20220113a.shtml
New Jersey Mandated Health Benefits Advisory Commission. (2019, May). A Study of New Jersey Assembly Bill 45303. Retrieved from New Jersey Department of Business and Insurance : https://www.nj.gov/dobi/division_insurance/mhbac/a4503.pdf
New Mexico Department of Health. (2022). 2.0 Contraceptive Methods. Retrieved from Family Planning Program Protocol: https://www.nmhealth.org/publication/view/policy/2060/
New Mexico Office of Superintendent of Insurance. (2022, 9 12). Cost-Sharing Protections for Contraceptives and PrEp and PrEP Endorsement Required. Retrieved from Bulletins: https://www.osi.state.nm.us/news/bulletins/bulletin-2022-016
Nikpour, G., Allen, A., Rafie, S., Sim, M., Rible, R., & Chen, A. (2020). Pharmacy implementation of a new law allowing year-long hormonal contraception supplies. Pharmacy, 8(3), 165.
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Qasba N, Wallace KF, Sopko J, Czajka J, Capoccia KL, Shcherbakova N, Goff SL. Twelve-month supply of short-acting contraception methods: Pharmacists' perspectives on implementation of new state law. J Am Pharm Assoc (2003). 2022 Jul-Aug;62(4):1296-1303.e2. doi: 10.1016/j.japh.2022.02.013. Epub 2022 Feb 22. PMID: 35307310.
Qasba NT, Dowd P, Bianchet E, Goff SL. A qualitative study of clinicians' perspectives on a law that allows for a 12-month supply of short-acting contraceptives in Massachusetts: Barriers and facilitators to implementation. Health Serv Res. 2022 Nov 22. doi: 10.1111/1475-6773.14105. Epub ahead of print. PMID: 36414429.
Rodriguez MI, Lin SC, Steenland M, McConnell KJ. Association Between Oregon's 12-Month Contraceptive Supply Policy and Quantity of Contraceptives Dispensed. JAMA Health Forum. 2022 Feb 18;3(2):e215146. doi: 10.1001/jamahealthforum.2021.5146. PMID: 35977278; PMCID: PMC8903112.
Uhm S, Chen MJ, Cutler ED, Creinin MD. Twelve-month prescribing of contraceptive pill, patch, and ring before and after a standardized electronic medical record order change. Contraception. 2021 Jan;103(1):60-63. doi: 10.1016/j.contraception.2020.10.011. Epub 2020 Oct 21. PMID: 33098853; PMCID: PMC7736567.
Yeatman S, Flynn JM, Stevenson A, Genadek K, Mollborn S, Menken J. Expanded Contraceptive Access Linked To Increase In College Completion Among Women In Colorado. Health Aff (Millwood). 2022 Dec;41(12):1754-1762. doi: 10.1377/hlthaff.2022.00066. PMID: 36469823.
**This Note has been updated since its original publication. Previous versions are not up-to-date, but can be accessed here: Version 1 (February 2022).
