Dive Brief:
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Although a provision of the Affordable Care Act required insurers to cover contraceptives without a co-pay, "I know, as many practicing physicians do, that it is not as simple as that," according to a recent Vox article by Tracey Wilkinson, an assistant professor of pediatrics at the Indiana University School of Medicine.
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Wilkinson's article echoes an observation of numerous publications in recent years, including the Kaiser Family Foundation in 2015, that insurer limitations and other administrative roadblocks still exist, effectively shutting many women out from this promised benefit.
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While the remaining limitations and workarounds typically don't break the law, they do significantly thwart the ACA's intent to remove the barriers to contraception coverage.
Dive Insight:
The main points Wilkinson aims to drive home are that birth control reduces unintended pregnancies, and that reducing unintended pregnancies saves insurers money.
The barriers are many, including difficulty getting information about exactly what prescriptions are covered by what insurers at any given time. Such basic information "was not always easy to find, readily available, or even known by the insurance company employees," the KFF found.
Other issues from the physician perspective include receiving and responding in a timely manner to questions or changes from insurers or pharmacists, and delayed feedback from patients who were unable to fill their prescriptions and were unable to immediately act on the problem, often due to issues around being adolescent or low-income.
Limitations are directly imposed by insurers through their choices of which options to cover, since they only have to offer one from each category of contraception, and through employing “reasonable medical management" to require that patients try a cheaper choice before being allowed to use the method they selected with their doctor, such as requiring a daily pill instead of a weekly patch.
Not only do such processes limit patients' choices, but requiring back-and-forth communication for documentation and approvals can significantly delay the filling of a prescription leaving patients at risk for unintended pregnancy in the meantime, and pushing away women fearful of loss of confidentiality.
Some change could perhaps be driven as a result of attention toward the drop in the U.S. unintended pregnancy rate, which researchers have attributed to significantly increased use of long-acting contraceptive methods such as the IUD (intrauterine device) and birth control implants. The rate went from 51% of all pregnancies between 2006 to 2010 to 45% between 2009 and 2013, according to a March 2016 study from the Guttmacher Institute.
As highlighted recently by Kaiser Health News, teens specifically saw a drop in their unintended pregnancy rate as well due to improved contraceptive use, dropping 36% from 2007 to 2013.