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Dispensing hormonal contraceptives in 1-year supplies saves state $43 million and avoids 15,000 unintended pregnancies

The rate of abortions and miscarriages also are reduced considerably when insurers cover dispensing of a 12-month supply of hormonal contraceptives to patients in California



Recent insurance coverage legislation enacted in California is expected to result in 15,000 fewer unintended pregnancies, 2,000 fewer miscarriages, and 7,000 fewer abortions, according to an analysis of the mandate’s potential impact by investigators at the University of California.1

Enacted in September 2016, the contraceptive supply legislation known as SB 999 requires health plans and insurers to cover a year-long supply of hormonal contraceptive pills, patches, and rings (formulations approved by the US Food and Drug Administration). Clinicians can now prescribe and pharmacists can dispense up to a 12-month supply at one time. California joins 5 other states and Washington, DC, that have such mandates.

Having a year’s worth of contraceptives on hand is anticipated to reduce the interruption in contraception use that may occur with a 30- or 90-day supply that needs frequent refilling and thereby lower the unplanned pregnancy rate as well as associated health care costs.

Understanding the legislation’s impact on the population’s health outcomes will be useful for other states considering similar proposed legislation.

Details of the study

In a short communication published in Contraception, McMenamin and colleagues described how University of California faculty and researchers, engaged by the California Health Benefits Review Program, assessed the utilization and cost implications of SB 999 and arrived at their estimated projections.1

The assessment was based on a literature review (including current use of hormonal contraceptives, unintended pregnancy rates among contraceptive users, and assumptions about shifts in dispensing patterns for contraceptive supplies), a survey of the state’s 5 largest health insurance providers, and a claims database review of the utilization and cost implications of SB 999.

Two scenarios. Projections for the use and costs of hormonal contraceptives were made for 2 situations: whether SB 999 was enacted into law or not. Approximately 25 million Californians would be affected by the legislation, including 744,000 who used hormonal contraceptives in 2016.

To calculate their projections, the researchers used a baseline estimate of a 9% unintended pregnancy rate among current users of hormonal contraceptives (or 67,000 unintended pregnancies leading to 28,000 live births, 9,000 miscarriages, and 30,000 abortions).2 They also used a previously reported 30% reduction in the odds of unintended pregnancy with 12-month dispensing.3

Impact of shift in dispensing patterns

With SB 999 versus without SB 999, a 30% reduction in the odds of unintended pregnancies would lead to 6,000 fewer live births, 2,000 fewer miscarriages, and 7,000 fewer abortions.

The legislation would also reduce projected health care expenditures. Total net health care costs would decrease by 0.03%, for a savings of about $43 million, due to avoidance of unintended pregnancies and related medical costs.

Benefits will be even greater over time

The authors noted that the reductions in unintended pregnancies and associated health care costs with the implementation of SB 999 may be even greater in later years as beneficial health outcomes and cost savings accrue over time.

This study’s findings provide support for the implementation of similar legislation in other states.

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