Study Shows Significant Cost Savings for VA in Allowing for 12-Month Dispensing of Oral Contraceptive Pills
BACKGROUND:
Like most US health plans, VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). However, 12-month OCP dispensing has been shown to improve continuation, decrease coverage gaps, and reduce unintended pregnancy in other practice settings. Despite mounting evidence favoring 12-month dispensing strategies for improving contraceptive access and reproductive outcomes, the financial consequences for VA are unclear, and will likely shape policy decisions. Thus, this study sought to determine the expected financial and reproductive health implications for the VA healthcare system in implementing a 12-month dispensing option for oral contraceptive pills. Investigators developed a decision model – from the VA payer perspective – to estimate incremental costs to the healthcare system of allowing the option to receive 12 months of OCPs upfront, as compared to the standard three-month maximum, over one year. The decision analysis model used in this study assumed a cohort of reproductive-aged, heterosexually active female VA enrollees who wish to avoid pregnancy. Pregnancy outcomes include abortion, miscarriage, and live birth. A cohort of 24,309 women was used to calculate total annual costs, based on the number of VA enrollees who filled an OCP prescription during fiscal year 2017.
FINDINGS:
- Adoption of a 12-month dispensing option for oral contraceptive pills is expected to produce substantial cost savings for VA compared to standard 3-month dispensing, while reducing unintended pregnancies among women Veterans.
- The 12-month dispensing option resulted in anticipated VA cost savings of $87.12/woman/year compared to 3-month dispensing, or an estimated $2,117,800 total saved annually. Cost savings resulted from an absolute reduction of 24 unintended pregnancies/1,000 women/year with 12-month dispensing, or 583 unintended pregnancies averted annually.
IMPLICATIONS:
- Investigators highlight financial gains as a secondary benefit to improving contraceptive access and facilitating women Veterans' individual abilities to manage their reproductive lives as they see fit.
LIMITATIONS:
- This model does not allow for switching to additional prescription methods over the 1-year time period, nor does it account for resultant pill wastage, which is a common counter-argument against extended medication dispensing.
- This model does not account for the possibility that groups of women Veterans choosing 12- versus 3-month OCP supplies may differ according to characteristics that impact OCP use, adherence, or risk of unintended pregnancy, including medical and mental health comorbidities
AUTHOR/FUNDING INFORMATION:
Drs. Mor and Borrero are part of HSR&D's Center for Health Equity Research and Promotion (CHERP).
Judge-Golden C, Smith K, Mor M, and Borrero S. Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Healthcare System. JAMA Internal Medicine. July 8, 2019;epub ahead of print.
