Policy Matters| Volume 29, ISSUE 5, P370-375, September 2019

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Factors Associated with New Uptake of Long-Acting Reversible Contraceptives Since the Affordable Care Act Among Privately Insured Women in Pennsylvania



      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.


      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.


      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.


      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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      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.


      Elizabeth Thayer, MD, is a current resident in the department of Obstetrics and Gynecology at University of Massachusetts Medical School in Worcester, MA.


      Celeste Bailey, MD, is a current resident in Obstetrics and Gynecology at Phoenix Integrated Residency in Phoenix, AZ.


      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.


      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.


      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.