Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods

Background: The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA's mandate has impacted long-acting reversible contraceptives (LARC) use is unknown. Objective: The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA's contraceptive mandate. Design: A retrospective cohort study using Truven Health MarketScan claims data from January 2010 to December 2013. Subjects: Women aged 18-45 years with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010-2013 (N = 3,794,793). Measures: Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time after the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics. Results: The proportion of claims with $0 cost-sharing for intra-uterine devices and implants, respectively, rose from 36.6% and 9.3% in 2010 to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P < 0.001). LARC uptake increased over time with no significant change in level of LARC use after ACA implementation in January 2013 (P = 0.44) and a slightly slower rate of growth post-ACA than previously reported (beta coefficient for trend, -0.004; P < 0.001). Conclusions: The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.