Prescription Contraceptive Sales Following the Affordable Care Act
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Prescription Contraceptive Sales Following the Affordable Care Act Lindsey Rose Bullinger1 · Kosali Simon2
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Objectives We examine trends in prescription contraceptive sales following the Affordable Care Act’s (ACA) zero-copayment contraceptive coverage mandate in areas more likely to be affected by the provision relative to areas less likely to be affected. Methods Before the ACA, several states had their own contraceptive insurance coverage mandates. Using a national prescription claims database combined with wholesaler institutional sales activity from January 2008 through June 2014, we compare sales of the intrauterine device (IUD), implant, injectable, pill, ring, and patch in states that had a state-level insurance coverage mandate before the ACA to states that did not. Results Overall, our results imply the ACA increased sales of prescription contraceptives, with stronger effects for some methods than others. Specifically, we find the ACA increased sales of injectable contraceptives, but had no significant impact on sales of the IUD, implant, pill, or patch in states without a state-level mandate before the ACA relative to states that had a state-level mandate. We also find suggestive evidence of a reduction in sales of the ring. Conclusions for Practice Demand responses to changes in out-of-pocket expenses for contraception vary across methods. Eliminating copays could promote the use of contraceptives, but is not the only approach to increasing contraceptive utilization. Keywords Prescription contraceptives · Affordable Care Act · LARC methods
Significance What is already known on this subject? The Affordable Care Act’s zero-copayment contraceptive coverage mandate reduced out-of-pocket expenditures by privately insured contraceptive users, but research studying the effects of the policy on utilization yields mixed results. What this study adds? Using proprietary pharmaceutical claims data, wholesaler institutional sales activity, and quasi-experimental methods, Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s10995-018-2680-1) contains supplementary material, which is available to authorized users. * Lindsey Rose Bullinger [email protected] Kosali Simon [email protected] 1
School of Public Policy, Georgia Tech, 685 Cherry St., Atlanta, GA 30332, USA
School of Public and Environmental Affairs, Indiana University, 1315 East Tenth Street, Bloomington, IN 47405, USA
2
we compare sales of prescription contraception in areas that were more likely to be affected by the policy to areas less likely to be influenced by the policy. We find the ACA’s contraception mandate increased sales of the injectable, but had no significant effect on the IUD, implant, pill, or patch relative to a comparison group.
Introduction A majority of women of childbearing age in the United States use some contraceptive method (Daniels et al. 2014). Contraceptive methods vary in price, and long-
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