Women have seen a 20% decrease in their out-of-pocket expenses for oral contraceptives and intrauterine devices since the implementation of the Affordable Care Act’s mandate to cover contraceptives without consumer cost sharing, according to a new analysis published in Health Affairs.
The average adjusted per claim out-of-pocket expense for oral contraceptive pills fell from $33.58 in June 2012 to $19.84 in June 2013, after the mandate took effect for most private health plans. For the insertion of an IUD, the average, per claim, out-of-pocket cost fell from $293.28 to $145.24 during the same time period, the researchers reported.
The researchers estimated that the average pill user saved about $255 a year, while the average savings on IUD insertions was about $248 per woman.
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The findings are based on an analysis of pharmacy and medical claims data from nearly 791,000 women aged 13-45 who were enrolled in private insurance for at least 1 month between January 2008 and June 2013 (Health Aff. 2015;34:1204-11 [doi:10.1377/hltaff.2015.0127]).
The ACA requires most private health plans to cover all methods of contraception approved by the Food and Drug Administration with no cost sharing as part of the preventive services mandate, although in practice, other studies have found some access issues remain despite the mandate. Many plans began implementing the contraceptive coverage mandate in January 2013, though in 2013 about a third of insured workers were still in a grandfathered plans that are not subject to the ACA’s requirements.
Within 10 months of implementation of the ACA’s contraception mandate, median spending for almost all contraceptive methods fell to zero and the average spending dropped by 38%-93%, depending on the method, according to the researchers. The reason that average spending remained above zero is that not all brands are required to be covered with no cost sharing, and some women in the study were enrolled in grandfathered plans.
“Our findings suggest the ACA mandate will likely significantly reduce the out-of-pocket expenditures of contraceptive users, in some cases to nothing,” Nora Becker and Daniel Polsky, Ph. D., both of the Wharton School at the University of Pennsylvania in Philadelphia, wrote. “But it is still too early to predict the final impact of the mandate on health care use and spending, or the mandate’s impact on other health and socioeconomic outcomes for women.”
Since many women are unaware of the ACA’s contraception coverage mandate, the impact of the mandate will “depend on how sensitive consumers are to out-of-pocket expenses for contraceptives and how many women were dissuaded from using contraceptive products by that expense before the mandate’s implementation,” they wrote.
The researchers reported having no financial disclosures.