Abstract
Background
The Affordable Care Act eliminated out-of-pocket costs for contraceptives, including
highly effective long-acting reversible contraception (LARC), for most insured women.
Patient characteristics associated with new LARC uptake after the Affordable Care
Act have not been well-studied. We hypothesized that awareness of no-cost intrauterine
device (IUD) coverage would be associated with new LARC use.
Methods
Data included were from 883 women not using a LARC at baseline who participated in
the MyNewOptions study, a 2-year study of privately insured women in Pennsylvania.
Multivariable analysis assessed whether the following baseline characteristics predicted
new LARC use over 2 years: awareness of no-cost IUD coverage, future pregnancy intention,
baseline contraceptive use, contraceptive attitudes, and sociodemographic characteristics.
Results
At baseline, 54.4% of participants were using prescription methods; 21.1% nonprescription
methods; 12.1% natural family planning, withdrawal, or spermicide alone; and 12.5%
no method. A minority (7.2%) was aware of no-cost coverage for IUDs. Over 2 years,
7.2% of participants became new LARC users, but awareness of no-cost coverage for
IUDs was not associated with new LARC use (adjusted odds ratio, 0.84; 95% confidence
interval, 0.27–2.55). New LARC use was associated with already using prescription
methods, not intending pregnancy within the next 5 years, prior unintended pregnancy,
and desire to change method if cost were not a factor.
Conclusions
Among privately insured women, wanting to switch methods if cost were not a factor
was associated with new LARC uptake, although awareness of no-cost IUD coverage was
not. Providing women with information about their contraceptive coverage benefits
may help women to seek and obtain the methods better aligned with their personal needs.
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Biography
Hallie N. Nelson, BS, is a medical student graduating from Penn State College of Medicine to pursue an Obstetrics and Gynecology residency at University of Rochester, in Rochester, NY. Her research interests include contraception and patient-centered care policies.
Biography
Elizabeth Thayer, MD, is a current resident in the department of Obstetrics and Gynecology at University of Massachusetts Medical School in Worcester, MA.
Biography
Celeste Bailey, MD, is a current resident in Obstetrics and Gynecology at Phoenix Integrated Residency in Phoenix, AZ.
Biography
Laura Leuenberger, MD, is a resident in the department of Internal Medicine at University of Michigan, in Ann Arbor, MI, with research interests in women's health.
Biography
Erik Lehman, MSc, is a biostatistician with the department of Public Health Sciences at the Penn State Hershey Medical Center. His interests include a wide variety of medical studies, working with local and national investigators.
Biography
Cynthia H. Chuang, MD, MSc, is Professor of Medicine, Public Health Sciences, and Obstetrics and Gynecology at the Penn State College of Medicine. Her research focuses on reproductive health care for adult women.
Article info
Publication history
Published online: July 20, 2019
Accepted:
June 17,
2019
Received in revised form:
June 13,
2019
Received:
November 14,
2018
Footnotes
This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CD−1304−6117). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient−Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.
Study data were collected and managed using REDCap electronic data capture tools hosted at the Penn State College of Medicine. REDCap is supported by the Penn State College of Medicine Clinical & Translational Science Institute, CTSI, NIH/NCATS Grant Number UL1 TR000127.
Author Disclosure Statement: No competing financial interests exist.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
