“WELCOME TO THE TIPPING POINT IN ORAL CONTRACEPTION PRESCRIBING” BY ROBERT L. BARBIERI, MD (EDITORIAL, JULY)
My thanks to Dr. Barbieri for the useful information and excellent clinical opinion he presented in his discussion of oral contraceptive regimens. I have a different answer, however, to his final question: “Why do we continue to prescribe 21-7 OCs?”
Having been in a private, community-based practice for 27 years, and not in a metropolitan medical center, the answer seems obvious to me: insurance and money. Most of my patients have insurance coverage that will not pay for a brand-name OC and do not have the financial wherewithal to pay for these new products out of pocket.
In theory, 24-4 and extended-cycle regimens should work better than what we have. But a patient who cannot afford a prescription for such regimens needs a reliable and fiscally responsible alternative.
Terry R. Brown, MD
Dr. Barbieri responds: Insurers can be slow responders
I appreciate Dr. Brown’s identification of insurance rules as a barrier to better prescribing practices for OCs. It will likely take time for insurance rules to catch up with best practices in OC prescribing.
Although cumbersome, and potentially difficult, for patients, an intermediate solution is to prescribe a generic pill and have the patient add 3 estrogen-progestin pills to the standard 21-7 regimen, turning it into a 24-4 regimen.