The number of privately insured women who paid no out-of-pocket costs for oral contraceptive pills rose from 15% in 2012 to 67% in 2014, according to a study published online Sept. 18 in Contraception.
Investigators with the Guttmacher Institute surveyed 892 women over 3-week periods in fall 2012, spring 2013, fall 2013, and spring 2014. The women were between 18 and 39 years of age, had private insurance, and used a prescription contraceptive method during any of the four study periods. Results showed that in spring 2014, 598 of the women had paid zero out-of-pocket expenses on oral contraceptive medication, compared with 134 women in fall 2012. Guttmacher analysts credited the increase with the Affordable Care Act’s contraceptive coverage requirement, which started implementation in August 2012.
In addition, the study found the proportion of women who paid nothing out-of-pocket increased from 20% in fall 2012 to 74% in spring 2014 among those using the vaginal ring and from 27% to 59% among women using injectable contraceptives. Of 165 women with private insurance who reported using intrauterine devices in fall 2012, 45% indicated that they paid nothing for the method. The proportion increased to 62% among new users in all three subsequent waves combined. (Contraception 2014 Sept. 18 [doi:10.1016/j.contraception.2014.09.006])
The analysis shows that the ACA’s contraceptive coverage guarantee has had a substantial and rapid impact on eliminating out-of-pocket costs among privately insured women who use contraceptives, the study authors noted.
Even so, Guttmacher researchers said there are still gaps in coverage because of federal guidelines that allow insurers to charge copayments in some situations and that exempt some employer-sponsored health plans on religious grounds.
The ACA’s contraceptive coverage mandate has been the subject of hundreds of lawsuits that argue the requirement violates religious freedoms. The U.S. Supreme Court in June ruled against the mandate as it was applied to two for-profit businesses, Hobby Lobby and Conestoga Wood Specialties. The companies are protected against the mandate by the 1993 Religious Freedom Restoration Act, justices said. In response to the decision, the Centers for Medicare & Medicaid Services on Aug. 22 proposed new rules to accommodate objections to the requirement to certain for-profit entities. Comments on the proposed rules will be accepted for 60 days before a final rule is issued.
Authors of the contraception study reported no conflicts of interest. The study on which this analysis was based was supported by the JPB Foundation, and additional support was provided by the Guttmacher Center for Population Research Innovation and Dissemination under a National Institutes of Health grant.
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