Research Activities, March 2014
Women with high insurance copays are less likely to use intrauterine devices for contraception
In August 2012, a mandate by the U.S. Department of Health and Human Services allowed women to receive contraception without cost-sharing under most private health insurance plans. Prior to this legislation, use of intrauterine devices (IUDs) was low among privately insured women in 2011. High insurance copays may have been one barrier to higher rates of use, suggests a new study. The researchers analyzed 2011 data from a database that includes more than 50 million non-retired employees enrolled in commercial employer health insurance. The study included 1,682,425 women aged 14 to 45 years with insurance coverage who used IUDs or oral contraceptives during the year. All were covered by their employer health insurance plans.
Overall, 5.5 percent of women began using an IUD in 2011. However, initiation of IUDs declined as costsharing increased. Women in the highest costsharing plans were 35 percent less likely to get IUDs compared to women in the lowest costsharing plans (4.4 percent vs. 6.7 percent). Co-pays for IUD initiation ranged from an average of $3 in plans in the lowest quartile of costsharing to an average of $162 in plans in the highest quartile. This compares to an average of $27 to $31 per month for branded oral contraceptives and $9 to $12 for generic oral contraceptives. Women younger than 20 years were also less likely to receive an IUD compared to women aged 20 to 34 years.
The researchers anticipate that the elimination of costsharing among plans under the Affordable Care Act will increase the use of highly effective long-acting reversible contraception such as IUDs and reduce rates of unintended pregnancy. The study was supported in part by AHRQ (HS15491).
See "The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance," by Lydia E. Pace, M.D., M.P.H., Stacie B. Dusetzina, Ph.D., A. Mark Fendrick, M.D., and others in the November 2013 Medical Care 51(11), pp. 959-963.