ACA's contraceptive mandate lowers costs, expands choice for women

Document titled "Patient Protection and Affordable Care Act"

New research indicates the Affordable Care Act’s (ACA) contraceptive mandate has expanded birth control choices for women while limiting out-of-pocket costs that served as a barrier to consistent contraception use prior to the law.

Following the ACA’s 2012 mandate that insurers fully cover all contraceptive methods approved by the Food and Drug Administration (FDA), the percentage of oral contraceptives filled at no cost to the patient rose drastically, from six percent to 92%, according to a Health Affairs study. The law also expanded options for those with employer-sponsored health coverage. Women were more likely to choose long-term birth control options—such as an intrauterine device or a contraceptive implant—that had significantly higher upfront costs prior to the ACA mandate.

The authors noted that long-term birth control methods are more effective than the pill, which could translate to “substantial” costs savings tied to unintended pregnancies.

 A separate Health Affairs study focused specifically on the use of oral birth control before and after the ACA mandate. Between 2010 and 2013, the average monthly cost for generic oral contraceptives for those with employer coverage dropped from $11.80 to $1.34, while brand name contraceptives declined from $35.06 per month to $15.61. Lower out of pocket costs for generic drugs were also associated with more consistent adherence and a lower likelihood of discontinuation. That level of consistency was more “complex” when it came to brand name drugs, which researchers attributed to a different patient mix along with a variety of outside factors.

“Our findings suggest that the ACA may play a role in improving consistent contraceptive use,” the researchers wrote. “However, continuation of and adherence to the pill remain suboptimal, which suggests that other factors are important contributors to these problems.”

Previous studies have found the ACA’s contraceptive mandate lowered costs by as much as $1.4 billion. FierceHealthPayer previously reported that adherence to birth control coverage requirements varies considerably among insurers.