Contraceptive Utilization Expected to Rise as Costs to Consumers Decrease

Cincinnati—The implementation of the Patient Protection and Affordable Care Act (ACA), which will provide contraception to consumers as a preventive service without cost sharing, is expected to result in an increase of contraception costs to payers that range from $0.43 to $1.02 per member per month (PMPM), according to information presented during a poster session at the AMCP meeting. The poster was titled Impact of the Patient Protection and Affordable Care Act Provision on Contraception as a Preventive Benefit: Contraception Costs for Commercial Health Plans.

Because no estimates existed on the impact this facet of healthcare reform would have on private health plans, researchers conducted a study for the time period of January 1 to December 31, 2009, to determine the PMPM cost resulting from the elimination of cost sharing. They also sought to examine the elasticity between cost sharing and utilization.

Commercial health plans that were not an HMO, point-of-service plan, consumer-driven health plan, or high-deductible health plan were eligible for study inclusion. Plans had to have both medical and prescription drug benefits covering at least 10,000 women between 15 and 49 years of age.

Using the 2009 Thompson Reuters MarketScan^® Research Database, the researchers examined models of utilization, cost impact, and consumer elasticity using 3 different coverage scenarios: (1) zero cost sharing for generic contraceptive methods only; (2) zero cost sharing for generic contraceptives as well as those that did not have a generic substitute; and (3) zero cost sharing for all generic and branded products and services.

The researchers calculated PMPM costs and utilization for oral contraceptives, vaginal rings, implantable rods, injectables, intrauterine devices (IUDs), and sterilization. Elasticity was defined as the change in quantity of a product consumed for each percentage point change in a member's cost sharing. The researchers applied elasticity factors to contraception utilization in all 3 scenarios to calculate change in net PMPM costs.

The net PMPM cost before reform was $2.39. Results showed that after the implementation of healthcare reform, increases in the national average cost to payers of contraception coverage were projected to rise $0.43 in the case of scenario 1; $0.61 in the case of scenario 2; and $1.02 in the case of scenario 3.

Price elasticity was demonstrated by 4 contraceptive methods: (1) oral contraceptives, (2) vaginal rings, (3) injectables, and the (4) IUD. In particular, use of the IUD increased per 1000 women as member cost sharing decreased. Utilization for the remaining methods also increased as cost sharing decreased, but this mainly resulted from improved compliance among existing users and not an increase in the number of users. The researchers also expected that because of the shifting of the generic copayment to zero, and branded products continuing to have a copayment, some women will switch from a brand oral contraceptive to a generic brand.

The study findings are admittedly the result of many assumptions, which is one limitation of the study. Further, national average costs presented were for typical populations, and variations may exist in specific populations. The effect of healthcare reform on unintended pregnancies was also not taken into consideration.

This study was supported by Bayer HealthCare Pharmaceuticals.