The VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). But a 12-month cycle for OCPs improves adherence, reduces coverage gaps, and reduces unintended pregnancy, say researchers from University of Pittsburgh and the VA Pittsburgh Health Care System, both in Pennsylvania. Not only that, they add, the VA could save > $2 million a year.
OCPs are among the most commonly used methods of contraception among women veterans. VA data indicate that 43% of women dispensed 3-month supplies experience ≤ 1 gap of ≤ 7 days between refills during a year of use. Citing research that has found women on 12-month dispensing cycles have fewer gaps, which leads to fewer unintended pregnancies and abortions. US guidelines now recommend routine initial dispensing of up to 1-year supplies of hormonal contraception.
However, the financial consequences for such a switch in the VA were unclear, the researchers say. To find out, they developed a decision analysis model from the VA perspective to compare incremental costs of a 12-month supply vs a 3-month supply dispensed quarterly. Basing their model on a cohort of 24,309 women, the researchers looked at the effects of each strategy on resulting coverage gaps, discontinuation of OCPs, pregnancy, birth, miscarriage, and abortion.
The model projected that the 12-month system would reduce unintended pregnancies by 14%, or 583 unintended pregnancies averted annually—a conservative estimate, the researchers say.
Overall, the model estimated total savings of > $2 million annually.
Their results suggest obvious financial benefits for the VA—for example, less money spent on intrapartum care, the researchers say. But they add, “it is vital that contraceptive policies serve first and foremost to augment women’s reproductive outcomes and autonomy.” They highlight the potential financial gains as a “secondary benefit to the more important and evidence-based goal of improving contraceptive access.”