Three-Month Maximum

As with most U.S. health plans, the VA currently stipulates a three-month maximum dispensing limit for all medications, including oral contraceptive pills. The researchers sought to estimate the financial and reproductive health implications for the VA of implementing a 12-month OCP dispensing option, with the goal of informing policy change.

To do that, they developed a decision model from the VA payer perspective to estimate incremental costs to the healthcare system of allowing the option to receive a 12-month supply of OCPs up front, compared with the standard three-month maximum, over a year. The assumptions were based on a model cohort of more than 240,000 reproductive-aged, heterosexually active, female VA enrollees who wish to avoid pregnancy for at least a year. At the same time, published data were used to calculate probabilities of continuation of OCP use, coverage gaps, pregnancy and pregnancy outcomes, costs of OCP provision and pregnancy-related care and the number of women using OCPs obtained from VA administrative records.

Results indicated that the 12-month OCP dispensing option resulted in anticipated VA annual cost savings of $87.12 per woman compared with the cost of three-month dispensing, which amounted to a savings of more than $2 million annually.

Cost savings resulted from an absolute reduction of 24 unintended pregnancies per 1,000 women per year with 12-month dispensing; overall, 583 unintended pregnancies would be averted annually.

The study team noted that expected cost savings with 12-month dispensing were sensitive to changes in the probability of OCP coverage gaps with three-month dispensing, the probability of pregnancy during coverage gaps and the proportion of pregnancies paid for by the VA. When simultaneously varying all variables across plausible ranges, the 12-month strategy was cost saving in 95.4% of model iterations, the authors wrote, adding, “Adoption of a 12-month OCP dispensing option is expected to produce substantial cost savings for the VA while better supporting reproductive autonomy and reducing unintended pregnancy among women veterans.”

Background information in the article explained that pill pack quantity per fill is primarily determined by the patient’s insurance. In the United States, medication dispensing is typically limited to 30-, 60- or 90-day supplies, as a mechanism to control costs, with three-month supplies increasingly common among commercial and public insurers because of improved adherence and cost savings for patients and payers.

“Nevertheless, 90-day limits still necessitate multiple refills annually,” the authors write. “Gaps in OCP coverage due to prescription refill delays are an established barrier to perfect contraceptive use among U.S. women.”

“We see extended contraceptive dispensing as a win-win,” added Judge-Golden, “promoting women’s health and women’s autonomy to use birth control as they decide, while also being economically sustainable for the VA.”

“This is a great opportunity for the VA to roll out this policy change on a national level and continue to be a leader and set an elevated standard for women’s health care,” emphasized senior author Sonya Borrero, MD, MS, director of Pitt’s Center for Women’s Health Research and Innovation and associate director of the VA’s Center for Health Equity Research and Promotion.

1. Judge-Golden CP, Smith KJ, Mor MK, Borrero S. Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Health Care System. JAMA Intern Med. 2019 Jul 8. doi: 10.1001/jamainternmed.2019.1678. [Epub ahead of print] PubMed PMID: 31282923; PubMed Central PMCID: PMC6618816.